Resectoscopic device and method

ABSTRACT

A surgical instrument has a channel dimensioned to receive a viewing instrument and enable the viewing instrument to be moved to or from a position near an optically transparent portion of a blunt, enclosed distal end of a shaft to provide unobstructed viewing through the distal end, and a position to the proximal side of an enclosed working area to provide viewing of the enclosed working area. A surgical instrument also or alternatively has a fluid routing switch within a shaft which can selectively connect a fluid infusion channel to at least one fluid export pore or a return channel. A method involves moving a viewing instrument to or from a position near an optically transparent portion of a blunt, enclosed distal shaft end and a proximal side of an enclosed working area. A method also or alternatively involves changing a position of a fluid routing switch within the shaft.

FIELD OF THE INVENTION

The present invention relates to surgical devices and, moreparticularly, to surgical devices used for resection of tissue fromwithin a body cavity.

BACKGROUND TO THE INVENTION

In surgical operations it is often necessary to insert tubularinstruments into small body cavities in order to manipulate, modify orresect pathological tissues which may include, for example, lesions,polyps, cysts, fibroids, lymph nodes, choroid tissues, and otherabnormal tissue growths, to name a few. When an instrument is introducedinto a body cavity during an operative procedure, in some cases,undesired tissue injury can be expected. However, the risk ofsignificant undesired tissue injury increases as the ability to viewwhat is happening with the instrument decreases. In other words, thereis significantly greater risk of injury when an instrument must beinserted and used “blindly” (i.e. only by feel) than there is when theinsertion path and area of use can be fully viewed.

While, in some cases, a potential undesirable injury such as alaceration or perforation may not present a significant risk so as torequire remedial action (i.e. it will heal on its own), in other cases,such as an injury occurring in an organ like the uterus, intestine orbowel, a laceration or perforation can be life threatening—in the formerorgan due to excessive bleeding and, in the latter organs, bypotentially causing peritonitis.

In general, the evolution of endoscopic surgical technology has vastlyreduced average morbidities for many operative procedures, and methodsfor resection of pathological tissue have improved over time. However,despite these advances organ lacerations and perforations still occur.Moreover, currently available technologies are designed to promotefreedom to the surgeon through a largely exposed cutting member and thusincrease, rather than decrease the possibility of causing undesirabletissue injury. In addition, current resectoscopic instruments aregenerally complicated, balky, and often require multi-componentreconfiguration during use.

When tissue is removed during a surgical procedure, capture of theresected tissue is necessary for surgical pathology testing.Unfortunately, in certain organs, efficient removal of pathologicaltissue from an operative site remains problematic. For example, withrespect to removal of pathological tissue from the uterus, the presentpractice for hysteroscopy follows a process beset by multiple taskinterruptions. The process begins with the trays containing thehysteroscope and resectosocopic instruments opened onto the sterilefield for assembly into one of two separate operational modes.

First, a diagnostic sleeve is usually set up for use with thehysteroscope to allow the surgeon entry into the uterus. The surgeonperforms an initial diagnostic hysteroscopy to identify the tissue(s) tobe removed and their location.

After the diagnostic hysteroscopy, the setup is withdrawn anddisassembled with the scope extracted from the assembly. A separateresectoscopic instrument is then assembled involving placement andalignment of an electrode upon the scope including electrode insertionand fixation into a small hole. A bridge piece is then inserted onto theassembly along with a new sleeve assembly. A fluid pressure regulator isattached to the inflow port of the instrument and a power source isconnected.

Now the resectoscopic instrument is carefully entered into the uterusafter further dilation of the cervix to accommodate its larger diameterand pipe-like tip. Here the surgeon must be very careful to avoidperforation of the uterus by the cutting tendency of the resectoscopeitself. In addition, the surgeon must avoid accumulation of endometriumtissues within the tip assembly since those tissues will obscure theview. If the view becomes too obscured, removal and cleaning prior toreinsertion is required.

Once the resectoscope is within the uterine cavity, the surgeon employscareful adjustment between the inflow and outflow valves to infuse fluidinto the uterus to open it and to remove fluid within the uterus whichhas become tainted with blood from the abrasion of tissues that isinherent with the insertion. Only when a balance between the inflow andoutflow is obtained such that where the uterus is opened and inflatedand the view is clear can the actual resection work begin. A typicalbalanced flow rate is around 10 cc/min.

The resectoscope is then maneuvered into position near the tissue to beresected and, with a clear view for resection, the loop electrode isextended beyond the distal end of the resectoscope. The loop is thenplaced near the tissue to be resected, the electroloop is activated, andthe loop is drawn back toward the resectoscope itself causing the loopto simultaneously cut off a piece of the tissue and cauterize the woundin the tissue left behind. The process of extension and withdrawal wouldthen be repeated until the full extent of the identified tissue isremoved. However, the process is rarely that straightforward. Moretypically, the resection process is repeatedly interrupted by cloggingof the tip assembly by tissue, or by sticking of the tissue to the loopitself. When this happens, removal, cleaning and reinsertion of theentire assembly may be necessary.

In addition, as noted above, each tissue piece must be captured forsurgical pathology. With the present devices, the resectoscope can beemployed to intentionally snare and remove each tissue piece, but thisrequires removal of the entire assembly to remove the individual tissuepiece, re-insertion of the resectoscope, abatement of any new bleeding,re-attaining of the proper the balance between fluid infusion andremoval to gain an adequate view, and only then, working on the nextsmall tissue piece to be resected. Alternatively, if the resectoscope isnot used, a tissue forcep may be blindly substituted for theresectoscope in order to attempt removal of the tissue. In either case,diagnostically important pieces of tissue may be lost in the effluviumof uterine deflation, or dropped and lost in the handoff from surgeon totechnician.

Still further, if cautery needs exceed the ability of the resection loopduring the process, the entire mechanism must be withdrawn anddisassembled to remove the electro-loop and substitute a roller-ballelectrode. Then, re-assembly, and subsequent re-insertion and fluid flowre-balancing are required in order to accomplish this phase of cautery.Then, if further resection is still necessary or desired after thecautery, the removal, reconfiguration, re-balancing, etc. process mustbe repeated.

Once the procedure is finally complete from the surgeons perspective,the process must continue for purposes of surgical pathology. In thatregard, the instrument is handed off to a technician who disassembles itand removes any tissue pieces that have attached to any of the multiplesleeves, auxiliary instruments, obturators, stop-cocks, scope, bridgepieces, holes and grooves. In addition, the electroloop is removed anddisposed of into the sharps container.

Since the instruments are all reused, after disassembly, the multipleelements must be transported to the area where final cleaning is donebefore sterilization and re-packaging. Thereafter, at some point atransport is required to return the now cleaned, sterilized and repackedunassembled kit and tray to the peri-operative supply area for its nextuse.

Some newer systems employ variations on the same basic free-flowhysteroscopic resectoscope in which an auxiliary instrument can beinserted through the hysteroscope for the purpose of tissue capture andremoval.

In some variants tissue morcellation is employed which requires time.Other variants require a complex opening mechanism to obliquely pass asmall auxiliary tissue cutting and capture instrument to thereby allowfor tissue capture and removal. These geometric changes increase thesize of the instrument and thus limit the use of the instrument to areasof the body or body cavity that can accommodate the size change and/oroverall increased size. These methods also involve optically guidedcapture and manipulation of tissue morsels in order to accomplish theirexport with or without further morcellation. Most of these variantmethods require interruption of cutting to allow for removal of resectedtissue. In addition, none of these variant techniques meaningfullyreduce organ perforation risk. Still further, to avoid removal of anexcessive amount of tissue, resection is typically done in a series ofpasses, with every pass involving a “guess” as to the required (andactual) depth of cut, particularly because gasses from tissuedestruction and heat largely obscure the cutting loop from precise viewduring the actual cutting. As a result, surgeons are forced to weigh andultimately succumb to the trade-off between over-removal with itsattendant risk of organ perforation or under-removal with the prospectthat a repeat procedure may, at some point, be necessary.

Removal of pathological tissue from other organs routinely involves, tovarying degrees, multiple steps of a somewhat analogous nature (i.e.multiple insertions/removals and issues relating to capture of resectedpathological tissue) and thus analogous or similar problems exist withthose operations as well.

As will be appreciated, the above example procedure to removepathological tissue from the uterus is time consuming and typicallytakes between 30 and 60 minutes to perform. With operating room costsexceeding several thousand dollars an hour, this can lead to substantialcosts for a patient as well as the hospital in which the resection isperformed.

Thus, there is a need for a surgical device that does not suffer fromproblems attendant with existing devices.

In addition, there is a need for a surgical device that can reduce thetime required to perform a resection procedure and thereby, the costsassociated with doing so.

SUMMARY OF THE INVENTION

I have devised an instrument that can be used for resection of lesionsor tissue that significantly reduces the above problems.

One example aspect involves a surgical instrument including a shafthaving a proximal end and a blunt, enclosed distal end, the blunt,enclosed distal end being optically transparent over at least a portionof its area, a scope having a viewing end that is moveable within theshaft between a first position and a second position such that when inthe first position within the shaft, the viewing end will be on a distalside of a working area within which resection can occur and proximate tothe optically transparent portion of the distal end and provide anunobstructed view external to the blunt, enclosed distal end and when inthe second position within the shaft, the viewing end will be on aproximal side of the working area and provide a view of the workingarea.

An alternative aspect involves a surgical instrument having alongitudinal shaft including an enclosed, blunt distal tip, an internalfluid flow path and an externalizable fluid flow path. The longitudinalshaft also has a working area defined by an opening in a side of thelongitudinal shaft, located within the internal fluid flow path, and aswitch, coupled to the internal fluid flow path and the externalizablefluid flow path which will control infusion fluid flow into the internalfluid flow path and the externalizable fluid flow path.

Another alternative aspect involves a method made up of: viewinginsertion of a shaft, having a blunt, enclosed distal end, into a bodycavity through the blunt distal end via an optical element locatedproximate to the distal end; causing a fluid flowing along the shaftfrom a proximal end to a distal end to exit the shaft through at leastone export pore; changing a switch setting such that the fluid flowingin the proximal to distal direction will bypass a working area and, oncepast the working area will flow in the distal to proximal direction andpass through the working area; and causing a discrete piece of tissue toenter the working area so that it will be conveyed in the distal toproximal direction by the flow of the fluid.

Various implementations of my invention can provide one or more of thefollowing advantages: fully integrated functionality, reduction intrauma from insertion, reduction in time to perform a resectionprocedure, accurate targeting of tissue to be resected, automaticlimiting of cutting depth, and/or capture and export of all resectedtissue and debris. Moreover, certain implementations can be disposable,in whole or part, resulting in cost savings due to avoidance of cleaningand re-sterilization issues.

Variants of the invention are suitable for use in, among others,gynecological, urological, proctological, thoracic, neurological,pulmenological, otolaryngological, gastrointestinal and laparoscopicprocedures as well as other procedures in which a minimally invasive andminimally traumatic tissue resection is necessary or desirable.

Variants implementing the invention provide a further pathologicalbenefit not available with current resection tools like macerators,morcellators and electrosurgical loops or knives. One problem withmacerators and micro-morcellators is that they destroy large amounts oftissue, rendering them less suitable for pathological examination.Electrosurgical loops or knives that cauterize as they cut create a zoneof tissue destruction on the edges of each side of the cut that istypically about 10 microns deep. While this zone is consideredpathologically acceptable, it nevertheless represents a zone ofpathological uncertainty. Advantageously, with variants that implementthe invention, the size of the resected tissue pieces can be larger thanwith currently available devices resulting in a greater ratio ofundamaged to destroyed tissue and, consequently, a larger volume ofpathologically examinable tissue.

Moreover, the protected nature of the cutting part of the device reducesor eliminates the risk of organ perforation, allowing for performingbi-directional resection—in contrast to the way surgeons are taught toperform resections with conventional instruments.

In addition, different variants can provide one or more of the followingfurther advantages: quick functional change among operational modes(i.e. inflation, viewing, resection, irrigation, etc.); true dualconformation with immediate re-conformation; single hand manipulationand control; fluid switching and internalization with vacuum actuatedflow boosting for accelerated tissue export; automatic transfer andcapture of resected tissue; intrinsic depth of cut control; eliminationof separate and discrete insertion or extraction of obturators, tissuechoppers; elimination or reduction in the use of accessory instrumentsor undertaking cycles of insertion, cavity infusion, target acquisition,withdrawal, disassembly, reassembly, reinsertion, subsequent cavityreinfusion & target reacquisition, etc. saving effort, time and,consequently, money; unobstructed panoramic diagnostic viewing pre andpost-resection; a protected resection mechanism; minimally traumaticinstrument insertion and manipulation; and inhibition or prevention oforgan perforation by an activated electrode under proper use.

The advantages and features described herein are a few of the manyadvantages and features available from representative embodiments andare presented only to assist in understanding the invention. It shouldbe understood that they are not to be considered limitations on theinvention as defined by the claims, or limitations on equivalents to theclaims. For instance, some of these advantages are mutuallycontradictory, in that they cannot be simultaneously present in a singleembodiment. Similarly, some advantages are applicable to one aspect ofthe invention, and inapplicable to others. Thus, this summary offeatures and advantages should not be considered dispositive indetermining equivalence. Additional features and advantages of theinvention will become apparent in the following description, from thedrawings, and from the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a simplified side view of one example variant of aresectoscope incorporating the present invention.

FIG. 2 is a simplified view of the shaft component of the resectoscopeof FIG. 1;

FIG. 3 illustrates, in simplified form, the trolley mechanism for thevariant of FIG. 1;

FIG. 4 illustrates, in simplified form, the example control mechanismfor the instrument of FIG. 1;

FIG. 5 illustrates, in simplified form, an example handle 102 for theresectoscope variant of FIG. 1;

FIG. 6 illustrates, in simplified form, a top view of a portion of thedistal end of the shaft;

FIG. 7 illustrates, in simplified form, an external end view of theblunt distal end portion of the shaft;

FIG. 8 illustrates, in simplified faun, a longitudinal cross section ofthe portion of the shaft of FIG. 6;

FIG. 9 illustrates, in simplified form, an alternative “switchless”variant;

FIG. 10 illustrates, in simplified form, another alternative variant;

FIG. 11 illustrates, in simplified form, a longitudinal, cross sectionalside-view of a further alternative shaft portion;

FIG. 12 illustrates, in simplified form, an example sliding control reedconfigured for use in conjunction with the shaft portion of FIG. 10;

FIG. 13 illustrates, in simplified form, the portion of the resectoscopeof FIG. 8 as it would look during insertion;

FIG. 14 illustrates, in simplified form, the portion of the resectoscopeof FIG. 8 as it would look during the “working” or resection process;

FIG. 15 illustrates, in simplified form, the portion of the resectoscopeof FIG. 8 with the telescope or viewing apparatus moved ahead of thecutting member;

FIG. 16 illustrates, in simplified form, the portion of the resectoscopeof FIG. 8 in an optional third configuration; and

FIGS. 17-20 illustrate, in simplified form, different stages of tissueresection using the resectoscope.

DETAILED DESCRIPTION

FIG. 1 is a simplified side view of one example variant of aresectoscope 100 incorporating the present invention. As shown in FIG.1, this example resectoscope 100 is, in summary overview, made up of apartially hollowed out handle 102 and a control mechanism 104, both ofwhich will be described in greater detail below, a shaft 106 connectedat its proximal end to the handle 102, a port through which a telescopeor other viewing apparatus, which may or may not involve use of fiberoptic technology can be inserted (not shown), and a finger grip 108 onthe shaft 106. The resectoscope 100 further includes a trolley mechanism110 that facilitates movement of the telescope or other viewingapparatus that is contained within the shaft, a stop 112 that acts as ahandle to allow manipulation of the trolley 110 and also limits movementof the trolley 110 mechanism towards the distal end 114 of the shaft, apower connector 116, a fluid inlet 118 and a vacuum port/fluid outlet120. As can be seen in FIG. 1, the tip 122 of the shaft 106 at thedistal end 114 is formed so as to have a physically closed blunt shapeto dramatically reduce, if not eliminate, puncture or laceration risk.In addition, the shaft includes an opening or resection port 124 locatedon a side surface 126 of the shaft 106 near the distal tip 122.

Depending upon the particular implementation and intended use, thelength of the shaft 106 can be anywhere from relatively short, forexample (i.e. a few centimeters or less) where a shallow body cavity isinvolved, relatively long (i.e. in excess of 40 centimeters) where longcavities like the bowel or intestines are the intended application, orlengths in between, for applications such as intrauterine resection.Similarly, depending upon the particular implementation and intendeduse, the shaft can be rigid along its entire length, flexible along aportion of its length, or configured for flexure at only certainspecified locations.

Still further, in some implementation variants, the shaft can be made upof two or more detachably interlocking segments 128, 130 for purposes ofmodularization.

The fluid inlet 118 is configured for connection to an adjustablepressure fluid infusion line via a stopcock 132 or other appropriatevalve and, in most cases, also having a parallel free flow one way fluidreservoir to accommodate vacuum boosting.

The vacuum port/fluid outlet 120 is configured for attachment to, forexample, a foot-pedal actuated boosted vacuum source via a stopcock 134or other appropriate valve.

FIG. 2 is a simplified view of an example shaft 106 component suitablefor use as part of the resectoscope of FIG. 1 and further includes crosssectional slices 2A through 2D taken at the points indicated toillustrate various features of this example implementation. Moreover,and advantageously, in some variants, the shaft 106 itself is separablefrom the non-handle components that make up the body of the resectoscope100, for example as in FIG. 2, and in some cases, made up of two or morediscrete modules. Some shaft variants are also disposable, whereasothers can be sterilized for reuse. In general, the shaft 106 is fannedas a hollowed multi-channel shaft or cannula, the details of which areexplained with reference to the cross sectional slices of the shaftshown in FIGS. 2A through 2D taken at 2A-2A, 2B-2B, 2C-2C and 2D-2D.However, it should be understood that the cross sectional shapes aresimply for illustrative purposes, the particular cross sectional shapebeing more relevant to the particular application for which theresectoscope will be used than to the invention.

Referring now to the cross sectional slice of FIG. 2A taken at 2A-2A,this variant of resectoscope shaft 106 incorporates a channel or portalfor a telescope or other viewing apparatus 202, a fluid infusion channel204 through which fluid can be infused from the proximal end towards thedistal end, a capture or return channel 206 through which fluid andresected tissue morsels are conveyed from the distal to the proximalend, one or more optional auxiliary channels 208 or other arrangement ofappropriate size extending to at least the working area and, if desired,to the distal tip itself to allow for, for example: further connectionsto be made; objects, for example, catheters, drains, ureteral stents ortubal occlusion devices to be inserted; to provide a brief flow ofliquid nitrogen or other cryo-cautery fluid to accomplish hemostasis;allow for passage of an auxiliary cauterization element to performconventional cautery; or allow for a stylet to be passed to the vicinityof the working area or beyond the distal tip. In addition, in thisvariant, the shaft 106 is of a different modular configuration from thatof FIG. 1, with the grip 108 of this variant being used as a coupler tocouple a main portion 200A of the shaft from a proximal portion 200B.The shaft 106 also optionally includes a pair of guides 210 that limitthe cutting member in this variant to longitudinal movement. In thisillustrated variant, the guides are configured for when anelectrosurgical wire loop is illustratively used (not shown in thisFIG.).

The cross sectional slice of FIG. 2B taken at 2B-2B is similar to thatof cross section 2A-2A except that the guides 210 are not presentbecause, in this variant, they are not needed along the entire length ofthe shaft 106.

The cross sectional slice of FIG. 2C taken at 2C-2C is also similar tothat of cross section 2A-2A except, because this section is beyond theentry point for the infusion fluid the fluid infusion channel 204 is nolonger present. In addition, this portion of the shaft will be situatedabove the handle 102 so, as will be described later, the return channel206 is open 212 to the handle 102 for reasons that will become evidentbelow. It also contains a pair of handle guides 214 that allow forattachment/detachment of the handle or shaft relative to the other, andguides 210 (similar to that shown in FIG. 2A) for a proximal portion ofthe wire loop apparatus.

The cross sectional slice of FIG. 2D taken at 2D-2D is similar to thelower portion of FIG. 2C with respect to the handle guides 214 and alsoincludes a handle cap portion 216 and a trolley guide 218 to receive thetrolley 110 mechanism.

FIG. 3 illustrates, in simplified form, the trolley 110 mechanism forthe variant of FIG. 1. As shown, the trolley mechanism may be of solid(FIG. 3A) or hollow (FIG. 3B) cross sectional configuration (or somecombination thereof) and includes a companion insert port 302 for theport 202 referred to in FIG. 1 through which a telescope or otherviewing apparatus can be inserted, an exit port 304 that will guide andalign the telescope or viewing apparatus for proper engagement with thechannel or port 202 of the shaft 106, a pair of rails 306 on each sidethat conforms in shape to the trolley guide 218 of the shaft 106, forexample, the sliding “v-groove” arrangement shown, a pair ofstops/handles 310 that can be used to move the trolley 110 through itsrange of motion along the longitudinal axis of the shaft 106 and act asa forward-movement limiting element, and a constraining arrangement 312a, 312 b that will clamp, affix or otherwise constrain the telescope orviewing apparatus (once fully inserted) in a particular orientation.

As shown, the telescope or viewing apparatus can be anchored to thetrolley by a grooved nipple-pin pit 312 at the proximal end. Two groovedpits 312 a, 312 b are seen on the proximal end, one above, and one belowthe channel 314 between the two ports 302, 304. These grooved pits 312a, 312 b accept the anchoring pin found on conventional scopes, andthrough provision of two such pits 312 a, 312 b, allow for rotation ofthe scope through 180° to allow for viewing in either a downward orupward inclination when, for example, angled scopes of, for example,common angles such as 12°, 30°, or 45° are used. This feature aids inoblique optical targeting through the opening or resection port 124.With and angled scope and the scope attachment pin in the inferior pit312 a, the scope is thus directed to an upward viewing angle providing,with those variants, a direct line-of-sight through resection port 124to the target area for direct optical targeting.

Advantageously, by affixing the telescope or viewing apparatus to thetrolley 110 movement of the trolley 110 along the guides 218 will effectequal movement of the portion of the telescope or viewing apparatus inthe shaft 106 towards or away from the distal end 114. In this manner,the trolley 110 provides an external visual indication of the locationof the end of the telescope or viewing apparatus.

At this point it should be noted that the telescope or viewing apparatusper se is conventional in the sense that numerous types are already wellknown and regularly used in performing various types of surgery. Theparticular type of apparatus, be it a telescope, fiber optic or otherdevice, is conceptually unimportant for an understanding of theinvention so long as an appropriate one is selected in terms of size,bevel angle if applicable (i.e. 0°, 12°, 30°, etc.), field of view,type, etc. so as to be compatible with the concepts described herein.Moreover, as will be discussed below, in some cases, two or moredifferent telescopes or viewing apparatus may be used, for example, tochange among different conventional bevel angles. Thus, except as isspecifically pertinent to an understanding of the invention, particulardetails regarding the telescope or viewing apparatus are omitted forboth brevity and simplicity.

FIG. 4 illustrates, in simplified form, the example control mechanism104 for the instrument of FIG. 1. As illustrated, the control mechanism104 includes a movement ring 402 that is used to maneuver a cuttingmember (described below) through its range of motion via a connection404 thereto. In addition, the control mechanism 104 can be arranged tocooperate with or constrain the trolley mechanism as necessary to effectthe desired operation. In addition, in this particular variant, thecontrol mechanism optionally includes a power connection 116 throughwhich power can be supplied to a cauterization element which may or maynot be the cutting member.

FIG. 5 illustrates, in simplified form, the handle 102 for theresectoscope variant of FIG. 1. As shown, the handle 102 includes anoptional finger hole 502 that facilitates manipulation of theresectoscope 100 during insertion or while in use. In addition, thehandle 102 has an internal cavity 504 of sufficient size to enablecapture of the resected tissue entering via the return channel 206through an opening 506 in the top of the handle 102 while allowing forthe unobstructed, filtered exit of the return fluid via the vacuumport/fluid outlet 120. In addition, as noted above, the handle 102 alsohas a pair of rails 508 on each side of the upper portion that conformsin shape to the handle guides 214 shown in the cross sections of FIG. 2Cand FIG. 2D.

As shown, the handle 102 for this variant also optionally includes afluid inlet hose guide 510 that keeps the fluid inlet hose out of theway.

FIG. 6 illustrates, in simplified form, a top view of a portion 600 ofthe distal end 114 of the shaft 106 near the tip 602. Note that, forclarity of presentation, internal details have been omitted from thisview. As can again be seen from this view, the distal end 114 is formedso as to have a physically closed blunt shape 122. In addition, as shownin more detail in FIG. 6, the shaft 106 includes an opening or resectionport 124 of a geometrically closed shape that is located on a surface126 of the shaft 106 near the distal tip 602. In particular, asillustrated in this variant, the opening or resection port 124 islocated immediately above, and defines a working area for the underlyingcutting member and has a longitudinal length λ that is typically equalto or slightly less than the range of movement of the cutting member, inthis case, between its proximal and distal limits.

It should be understood that the size, shape and exact location of theopening or resection port 124 may vary depending upon the particularimplementation or intended use. Similarly, a sliding shim or cover platecan be incorporated, for example, to provide size or shapeadjustability, and even, in some cases, to close off the opening orresection port entirely, for example, to facilitate insertion into bodycavities where the opening or resection port in and of itself couldcause trauma during insertion or withdrawal. Depending upon theparticular implementation, in some variants, the movement of the shim orcover plate can be tied to that of the telescope so that when the scopeis fully extended the shim or cover plate will close off the opening orresection port 124 entirely or at least cover the cutting member itself.Optionally, for some applications, it may be desirable to ensure that aseal is formed between the periphery of the opening or resection portand the tissue about the tissue that would be resected, for example,when used in an application such as removal of tissue from a sinus orthe trachea which are both fairly rigid. In such cases, this desire canbe accommodated in any of multiple ways. One example approach caninvolve making some portion of the shaft about the periphery of theopening or resection port slightly flexible so that it can conform tothe abutting tissue. Another example approach can involve use of adeformable “gasket” material 606, such as a closed cell foam, putty, gelor other appropriate non-toxic deformable material. Depending upon theparticular use, such deformable material can be part of the shaft itselfor provided separately, that latter being advantageous for those caseswhere a surgeon may wish to have the option to do so up until about thetime that insertion of the shaft begins.

In addition, and advantageously, some variants may be implemented in akit that includes only certain components, for example, a shaft byitself, a shaft and handle, a shaft and associated cutting member,different length shafts, or multiple shafts of different lengths, crosssectional shapes and sizes, flexibility, curvature, or that each haveopenings or resection ports of a different size and/or shape so as tobetter match or accommodate the size and shape of the tissue to beresected and assist in confining the resected tissue within the shaft sothat, it can be conveyed along the shaft 106 for capture in the handle102.

Still further, in some cases it may be desirable to have a moremodularized shaft, in that, the shaft itself would be made up two ormore separable pieces, an extension section 608 representing the bulk ofthe shaft length, and a shaft module 610 containing some or all of theshaft components described herein as being located between the distalend and a location to the proximal side of the working area. In thismanner, a particular shaft module 610 could be used, for example, withdifferent length or flexibility shaft extensions 608 or differentconfiguration modules 610 could be used with a common shaft extension608 in a mix-and-match manner as needed or desired. In addition, thisapproach provides further advantages in terms of the ability to beproduced, production cost and configuration flexibility.

As illustrated by way of example, the opening or resection port 124 isof ovoid shape and the shaft is of a length and cross sectionappropriate for resection of tissue within the uterus. Advantageously,and irrespective of the dimensions of the shaft 106 or particular shapeof the opening or resection port 124, the opening or resection port 124defines the only zone for interaction between the cutting member and thetissue to be resected while acting as a passive port for removal offluid from the tissue area or body cavity.

Moreover, depending upon the phase of resectoscope use, the opening orresection port 124 will create the path for regulation of the“inflation”, if any, of the cavity where the resection will occur byacting as the outlet (from the perspective of the body cavity) forexcess inflation fluid and/or will serve as a passive functional portalfor fluid and/or tissue. Optionally, one or more small pore(s) 604 canbe provided, that couple to the return channel 206, to provide anadditional or alternative route for fluid external to the shaft to passinto the return channel 206, for example, during an inflation phasewhere it may be difficult or undesirable to do so through the opening orresection port. Depending upon the particular implementation, such porescan be sized small enough so that they do not de-inflate the cavityduring working or, alternatively, can be selectably blocked for example,by the slidable shim or some other means, so as to only be open at aparticular time, for example, only when, as will be described below, thetelescope or viewing apparatus is in the extreme distal position or whena switch is in a position where infusion fluid is routed out of theshaft for purposes of inflation or irrigation.

FIG. 7 illustrates, in simplified form, an external end view of a bluntdistal end 122 portion 700 of the shaft 106. As can be seen from thisview, at least a portion 702 of the tip 602 is optically transparent soas to act like a window and is aligned with the channel or portal 202for the telescope or viewing apparatus so as to provide for forwardviewing through the distal end portion 702 via the telescope or viewingapparatus under the appropriate conditions.

Depending upon the particular implementation, the optically transparentportion 702 can simply be a hole or it can be a physical element. In thecase of a physical element, it can be an integral part of the shaft, forexample, if at least that portion of the shaft is, or is made,transparent, or it can be a separately formed and inserted element, likea membrane, a piece of plastic or glass (whether flat or lens shaped) orother optically transparent material. Moreover, in some cases, thisportion 702 or window area can be, in whole or part, a lens that canwork in conjunction with the telescope or viewing apparatus to provide adifferent field of view than would be provided by the telescope orviewing apparatus alone. For example, the window area 702 could be anelement that is flat or convex on the external side of the distal end122, but flat and beveled at a specified angle on the internal side(i.e. inside the shaft) so that a comparably opposite beveled end of thetelescope or viewing apparatus can be butted against it to allow forstraight-ahead, angled or wide-field viewing (as determined by the shapeof the external side) when the trolley 110 is in the extreme forwardposition.

Alternatively, by appropriate sizing, the window area 702 can be a holethat, for purposes of insertion, can be filled or blocked by the end ofthe telescope or viewing apparatus itself through maintaining it in asuitably spaced extreme forward position.

Optionally, the auxiliary channel 208 can be carried forward to thedistal end 122, such as is shown. Additionally or alternatively, asshown in this variant, the portion 702 is ringed with an electricalconductor 704 that can be selectively connected to a power source todirectly effect cauterization while viewing the tissue to be cauterizedthrough the distal end 122.

FIG. 8 illustrates, in simplified form, a longitudinal cross section ofthe portion 800 of a shaft 106 of one example variant. In FIG. 8, thelongitudinal fluid infusion channel 204 and return channel 206 can bereadily seen as can the blunt nature of the distal end 122. Although asingle fluid infusion channel 204 is illustrated for simplicity, in somevariants, two or more separate inflow channels with combined orassociated individual respective controls could alternatively be used.In addition, a telescope 802 having a 30° bevel resides in the telescopechannel 202, at a retracted location, and is aligned with the telescopeend portal 804. In this variant, the telescope end portal 804 is cappedwith a lens 806 that is slightly convex on its outer surface 808 andbeveled 810 at a mirror image 30° bevel so that, at the extreme extendedposition, the end of the beveled telescope 802 and the internal surfaceif the lens 806 will mate.

The opening or resection port 124 described in connection with FIG. 5 isalso clearly visible.

A cutting member 812 also resides within the shaft 106. Depending uponthe particular intended use and implementation, the cutting member 812can be a wire loop (such as shown), a sharpened blade, a rotary cuttingimplement, a micro-vibrational or harmonic or shutter-type cuttingdevice, or other cutting implement (each with or without cauterizationcapability). Alternatively or additionally, the particular cuttingmember 812 can be configured for movement in an arcuate, axial,rotational, diagonal, transverse, reciprocating or other manner toeffect cutting in a direction other than through pure longitudinalmovement.

In yet other variants, the cutting member 812 can be configured so thatits orientation within the shaft 106 is changeable to provide forcutting at two or more different angles. In such variants, an auxiliaryor reconfigurable telescope or viewing apparatus may be necessary ordesirable to allow for angulation.

Depending upon the particular implementation, the cutting member can besupplied with, and integral to, the instrument or shaft as packaged orit can be of a separately provided snap-in and/or snap-out design.

Irrespective of the particular cutting member 812 used, its mode ofintegration with the shaft, and its direction of movement ororientation, the cutting portion of the cutting member 812 is whollyconstrained within the shaft. Moreover, ideally the cutting memberconforms, through at least a part of its range of motion, to either aninner or outer surface 126 of the shaft 106 and/or an imaginary surfaceof the opening or resection port that would be formed if the shaftcontour was continuous across the region of the opening or resectionport. Thus, if the shaft near the opening or resection port is arched,because the shaft is circular or oval in cross section, the cuttingmember will typically have a similar or lesser arch. If the shaft nearthe opening or resection port is flat or near flat, the cutting membercan be similarly contoured in shape.

However, if a type of cutting member 812 other than a wire or blade isused, for example a micro-vibrational or harmonic cutter (i.e. aharmonically vibrated blade), scissor or shutter-type mechanism, thecutting member may not follow the contour. This is not a problem, asfollowing the contour is not critical to implementation of the inventionbut highly desirable for some implementations or intended uses. Rather,the important aspect is that the cutting member 812 remains within theworking area, whether or not the cutting member 812 is a blade, loop,scissor, shutter, harmonic or other type of cutting mechanism.

For purposes of illustration, as shown in the variant of FIG. 8, thecutting member 812 is a wire loop that is moved by longitudinal movementof the forefinger loop 402 on the control mechanism 104 near the handle102 and is constrained against non-longitudinal movement by the guides210 of FIG. 2. As should be understood from FIG. 8, the cutting memberhas a height “h” that keeps it wholly within the shaft 106 through itsrange of motion from a fully distal position 814 to a fully proximalposition 816 and, in this variant, is curved in an arc of approximatelya 4 mm radius so that the telescope or viewing apparatus 802 can passthrough and underneath the cutting loop with minimal to no contacttherewith. In this regard, it should be noted that, at either or bothextremes 814, 816, the cutting member 812 may or may not be visiblethrough the opening or resection port 124. As a result, the cuttingmember 812 can “guarded” by the outer surface 126 of the shaft 106,thereby preventing it from causing undesirable laceration or puncture oftissue during insertion or at any point in the procedure where cuttingis not warranted or desired. Still further, through this configuration,the outer surface 126 of the shaft 106 limits the depth of cut, againgreatly reducing the risk of undesirable laceration or perforation.

In addition, in this variant, the shaft 106 includes one or more fluidexport pores 818 and a fluid routing switch 820 with the fluid exportpore(s) 818 being under the fluid routing switch 820 and beyond thetermination point 822 of the fluid infusion channel 204. The fluidexport pore(s) 818 can be of any geometric shape(s) or number.

As shown in FIG. 8, the fluid routing switch 820 is a binary positionpivoting switch that is sized and shaped so that, in one position (theinfusion position), the switch will direct a substantial portion, if notall, of the fluid passing through the fluid infusion channel 204, fromthe proximal end towards the distal end, and out through the fluidexport pore(s) 818, for example, in the case of a device forintrauterine resection, to inflate the uterus. In the other position(the circulation position), the switch 820 will substantially, if notcompletely, inhibit fluid flow out of the pore(s) 818 and instead,direct fluid into the return channel 206 in the vicinity of the openingor resection port 124. As illustrated in this variant, the switch 820 isnormally biased into the circulation position. Advantageously, thisallows the end 824 of the telescope or viewing member 802 to be used toactuate the switch 820 and divert the infusion fluid out the pore(s)818.

Optionally, in some variants, the internal surface 826 of the switch820, about the switch 820, and/or surfaces 828 facing the return channel206 (whether or not there is a switch) can be specifically inclined andpolished or otherwise made reflective so as to act like a mirror andenable a further or additional range of view through the opening orresection port than could potentially be available using only thetelescope or viewing apparatus (i.e. provide accessory opticalcapability for, for example, tissue targeting or cauterization).

Alternatively, in other variants, the fluid routing switch within theshaft 106 can be dispensed with entirely.

FIG. 9 illustrates, in simplified form, a “switchless” (with respect tothe shaft) variant 900 by employing at least two separate fluid inflowchannels 902, 904 routed to effectively create the two flow patternsobtained by the switch. In other words, at least one of the fluid inflowchannels 902 is connected to the export pore(s) (analogous to one of thebinary switch positions) and another of the fluid inflow channels 904 isconfigured to cause fluid to remain within the shaft and flow into andthrough the working area (analogous to the other binary switchpositions). Such a switchless variant has the advantage that, withrespect to the shaft itself, fluid routing becomes a passive function,formation of the shaft becomes simpler and a moving part is eliminated.As a result, it is easier to create an inclined polished or mirror areawithin the shaft as described above.

Of course, such a “switchless” approach would still require some form ofselection element which could be located, for example, on or adjacent tothe handle, the control mechanism, or wholly external to theresectoscope itself. In addition, this alternative approach enablesspecific control of the flows so that a dual or combination flow canoptionally be achieved (i.e. an intermediate point between full outputthrough the infusion port and full circulation flow at a desired flowrate).

FIG. 10 illustrates, in simplified form, an alternative shaft portion1000 variant that is similar to that of FIG. 8 except a portion of thedistal end 1002 is itself transparent, so no separate membrane, lens orother cap is required, there is specifically one circular infusion pore1004, and the opening or resection port 1006 is rectangular. Forcompleteness, FIG. 10A is a cross sectional slice of the shaft taken at10A-10A (through the pivot point of the switch), FIG. 10B is a crosssectional slice of the shaft taken at 10B-10B (through the infusionpore), and FIG. 10C is a cross sectional slice of the shaft taken at10C-10C (through a portion of the opening near the proximal working arealimit for the cutting member). In addition FIG. 10D illustrates a viewof the upper surface of the shaft 1000 taken from above the opening orresection port 1006.

FIG. 11 illustrates, in simplified form, a longitudinal, cross sectionalside-view of a further alternative shaft portion 1100 variant that usesa sliding reed as the fluid routing switch. In addition, in thisparticular variant the reed also optionally defines and segregates thefluid infusion channel 1102 from the return channel 1104. For ease ofunderstanding this variant, example cross sectional slices, taken at11A-11A through 11G-11G, are also provided in FIG. 11A through 11G. Forfurther simplicity, details such as the cutting member, its constraintand movement control, as well as any optional additional auxiliarychannel(s) have been omitted but it should be understood that any or allof them could also be present.

In this variant, two fluid export pores 1106, 1108 are provided and arebest illustrated in FIG. 11E. As illustrated in the various crosssectional slices, the fluid infusion channel 1102 splits into a pair ofsmaller channels 1110, 1112 as it approaches the distal end 1114 inorder to reach the two fluid export pores 1106, 1108. Fluid infusioninto the body cavity occurs via fluid flow from the fluid infusionchannel 1102, through the two channels 1110, 1112 to the fluid exportpores 1106, 1108. Again, it should be understood that each individualfluid export pore 1106, 1108 could be readily implemented as two or moreindividual pores. Alternatively, fluid circulation occurs via a fluidcirculation channel 1116 that is located between the two smallerinfusion channels 1110, 1112 and is shaped to direct the fluid into thevicinity of the working area 1120 for return down the return channel1104.

Of course, it should be understood that, in other implementationvariants, the fluid circulation channel could be split up into the twochannels and the fluid infusion channels could be the central channel,the only differences being a potential change in relative sizing of thechannels, the export pore(s) would be centrally located and there wouldbe two portions used to direct the flow into the working area to accountfor the split channels.

The above two variants reflect a desire for longitudinal symmetry aboutthe vertical. However, it should be understood that symmetry is notrequired and, in some variants, asymmetry may provide advantages forparticular uses or applications, for example, to cause a turbulent orspecific pattern of flow near the distal tip or working area. In suchcases, some form of side-by-side arrangement or other arrangement wouldlikely be used.

As noted above, one example variant mechanism for switching of fluidflow is comprised of a blade-like control reed which spans the hollowedshaft 106 transversely. The control reed also spans from proximal todistal within the shaft along the greater length of the instrument, andis held in place by small lateral grooves 1118 along the inner wall ofthe shaft. The control reed is capable of sliding longitudinallydistally and proximally along the shaft. FIG. 12 illustrates, insimplified form, an example sliding control reed 1200 configured for usein conjunction with the shaft portion of FIG. 11. As illustrated, whenthe control reed 1200 is within the shaft 106, it will create aneccentric partition axially along said shaft such that the inflowchannel 1102 lies beneath, and the larger outflow/return channel 1104lies above the control reed 1200 along the length of the shaft 106.Depending upon the particular implementation, the control reed 1200 maybe flat, such as shown, or may be curved in some manner to, for example,increase the diameter of the overlying return channel 1104, orcontribute to the overall stiffness of the instrument 100. Similarly,depending upon the particular design, control reed material or intendeduse for the instrument, the control reed 1200 itself can be reinforced,for example, by fins, ribs, or a differing thickness across its width oralong its length to increase stiffness or create a specific flexurepattern.

The control reed 1200 accomplishes its switching task through use ofholes 1202, 1204, 1206 located near its distal end 1208. The holes 1202,1204, 1206 are placed, sized and shaped to effect the desired fluid flowcontrol based upon the position of the control reed 1200 at a particularpoint in time. As illustrated, a center hole 1202 is located near thedistal end 1208 of the control reed 1200 and provides a flow path up andinto the working area 1120 when the center hole 1202 is aligned, inwhole or part, with the fluid circulation channel 1116. In addition, thecenter hole 1202 is located relative to the end of the reed 1200 so thatthe control reed 1200 can be placed in a position where an element 1122blocks all flow through that hole 1202. As illustrated, that position isan extreme forward (i.e. distal) position, but could alternatively be arearward position or some position in between.

In addition, the control reed 1200 contains a pair of lateral holes1204, 1206 to either side that can be aligned with the infusion channels1110, 1112 to direct fluid flow from the main fluid infusion channel1102 to the export pore(s) 1106, 1108. As with the center hole 1202, thelateral holes 1204, 1206 are located on the control reed 1200 so thatthey can, based upon the position of the control reed 1200, provide afluid flow path, in this case between the infusion channel 1102 andexport pore(s) 1106, 1108 (in this variant, in the vicinity of the shaft106 at the cross section taken at C-C), or to cut off all flow to theexport pore(s) 1106, 1108. As illustrated, in cross section B-B, in thisvariant, solid protrusions 1124, 1126 above the control reed groove 1118are positioned act so as to block flow through the lateral holes 1204,1206 when the control reed 1200 is at its most proximal operationalsetting. Of course, as with the central hole 1202, this lateral hole1204, 1206 blockage could also occur at a forward position or someposition in between.

For purposes of understanding, in the variant of FIG. 11 and FIG. 12,the distal end 1208 of the control reed 1200 and distal end slot 1128are arranged so that the control reed 1200 can move a distanceessentially equal to, or slightly more than, the diameter of the centralhole 1202. With the control reed 1200 in its proximal position, thelateral holes 1204, 1206 are blocked and the central hole 1202 is opento accomplish an internalized fluid circuit. Thus, with the control reed1200 in the proximal position, fluid will be passively directed from theinflow channel 1102 into the center channel 1116, creating a flowcircuit within the instrument's shaft 106. In the variant illustrated inFIG. 11, when assembled and in use, fluid flows in the distal directionfrom the inflow channel 1202 under the control reed 1200, and thenupward via a curved surface 1130 within the center channel 1116proceeding out through the center hole 1202 in the overlying controlreed 1200. The fluid then flows or is drawn proximally into theoutflow/return channel 1104 with or without vacuum assist. This is thetypical control reed 1200 position for resection.

In its distal position, the lateral holes 1204, 1206 of the control reed1200 are open while the central hole 1202 is blocked by the distal endslot 1128 so that fluid will be routed out the export pore(s) 1106,1108. Thus, as the control reed 1200 is moved to block the center hole1202, the nearest 1206 of two lateral pores 1204, 1206, one on eachside, will move from under the blocking surface 1124, 1126 and thusallow diversion of flow up and into the lateral channels 1110, 1112whose ultimate path leads to the export pore(s) 1106, 1108.

Depending upon the particular implementation, movement of the controlreed 1200 can be integral with movement of the telescope or viewingapparatus 802 or not. As shown, the sliding control reed 1200, whenwithin the shaft 106, is activated from the proximal end of theinstrument by an open linkage mechanism (not shown) to the trolley 110,and is automatically activated with full advancement of thescope/trolley in unison. The control reed 1200 is pushed forward by thetrolley 110, or independently by a finger leaving the trolley 110 in itshome/resection position. This allows, for example, uninterruptedre-inflation of the tissue cavity while keeping the telescope or viewingapparatus 802 in a diagnostic or targeting mode or during activeresection, as desired. Alternatively, movement of the control reed 1200can be made independent of the other components, for example, thetelescope or viewing apparatus 802. This can be accomplished in astraightforward manner by providing an element at or near the proximalend of the shaft 106 that is connected to the control reed 1200 andthus, its movement will move the control reed 1200.

Advantageously, some variants using the control reed 1200 arrangementfor fluid switching will thus, have the ability to provide variableflow, not readily obtainable via internal switching alone with thepreceding mechanical switch by: a) design, through placement, sizing andshape of the holes themselves so that, for example, there is an inverselinear ratio of diversion between completely internalized andexternalized flow as the control reed is moved, b) movement of thecontrol reed into any of an infinite number of intermediate positionsirrespective of the particular flow relationship provided by the holeplacement, shape and sizing, or c) both. As a result, finely controlledflow splitting between internalized and externalized routes can beachieved, for example, in order to maintain slow balanced cavityinfusion while concurrently performing resection with vacuum assistedevacuation and/or tissue export.

In general, the approach to controlling the fluid flow that is used toconvey the resected tissue from the working area towards the handle 102will likely vary depending upon the particular implementation andintended use. For example, in some cases, the control can be fullymanual. In other cases it can be a result of movement of anotherelement, for example the telescope or viewing apparatus of FIG. 8 or themovement of the cutting member itself. In yet other cases, the controlcan result from a combination of manual adjustment based uponmechanical, electric or electronic feedback. In yet other cases, fullyautomated control is possible through use of, for example, electricallyactivated fluid gates, electromagnetic, mechanical, hydraulic, or otherswitches. In some variants that use a distally placed switch that is notdirectly manipulable via an external control, the switch can be designedto be externally controlled through fluid flow itself in conjunctionwith vacuum, or through only positive pressure fluid flow (i.e. withoutthe use of vacuum at all). In addition, and advantageously, when in thefluid circulation mode or configuration (i.e. fluid will not flowgenerally out the export pore(s)) flow rates of 100 cc/min or more canbe used and, with vacuum boost, instantaneous flow rates within theshaft can exceed 4000 cc/min.

FIG. 13 illustrates, in simplified form, a cutaway view of a shaftportion 1300 for a resectoscope, that is similar to the shaft portion800 of the resectoscope of FIG. 8 except that the distal end has awindow area 702 that is made up of a transparent membrane 1302 insteadof a lens 806. As illustrated the shaft portion 1300 is configured as itwould look during insertion. In this configuration, the telescope orviewing apparatus 802 is fully extended (i.e. the trolley 110 has beenmoved to its forward limit position so that viewing out the window area702 of the shaft 106 is possible using the telescope or viewingapparatus 802. The cutting member 812 is in its “home” position which,although illustrated as being at the distal limit 1306 (due to thesurgical convention of preferably only cutting in the distal to proximaldirection due to the puncture risk inherent with conventional devices)it could alternatively be at a proximal limit or somewhere in between.In the fully extended position, the telescope or viewing apparatus 802impinges against the upper portion 1304 of the switch 820 therebyopening the fluid export pore(s) 818 to the fluid input channel 204 toallow fluid to pass out of the shaft 106 while preventing infusion fluidfrom directly entering the return channel 206 from inside the shaft 106.

Advantageously, it should be recognized that variants configured in thismanner can be used in circumstances where organ “inflation” may or maynot be necessary. For uses where inflation is not necessary, this isaccomplished by limiting trolley 110 movement or clamping the telescopeor viewing apparatus 802 such that, when the trolley 110 is in the fullyextended position, the telescope or viewing apparatus 802 will fall justshort of the upper portion 1304 and thus avoid actuating the switch 820.Although, by doing so, this could result in some minor reduction ordistortion in the forward field of view due to the gap between the endof the telescope or viewing apparatus 802 and the window area 702, anysuch reduction or distortion will likely occur, if at all, at theperiphery of the field of view so the reduction will have minimal to noimpact in most cases.

FIG. 14 illustrates, in simplified form, the portion of the resectoscopeof FIG. 13 as it would look during the “working” or resection process.As shown, in this configuration, the telescope or viewing apparatus 802is at or near its fully retracted position and, as a result, the switch820 will block passage of fluid to the fluid export pore(s) 818 andcause the infusion fluid to circulate up into the return channel 206where the applied vacuum will cause it to traverse towards the proximalend of the shaft 106. Moreover, the placement of the telescope orviewing apparatus 802 allows for unobstructed view of the opening orresection port 124 as the cutting member 812 is moved throughout itsrange to perform unidirectional or bi-directional resection. Inaddition, since they are independently maneuverable, the end of thetelescope or viewing apparatus 802 can be used to “clear” or dislodgeany resected tissue pieces that may get caught on the cutting member 812by simply moving the two with respect to each other so that thetelescope or viewing apparatus 802 passes by the cutting member 812.Still further, should the end of the telescope or viewing apparatus 802become partially or totally obstructed by tissue or clouded by turbidfluid from the resection (if any), the telescope or viewing apparatus802 can be moved forward of the cutting member 812 and into the cleanflow of infusion fluid, thereby cleaning the end without the need towithdraw the shaft 106 of the resectoscope 100 or the telescope orviewing apparatus 802 from the body cavity.

Alternatively or additionally, in instances where there are one or moreoptional auxiliary channels 208 present and a piece of tissue or debrisbecomes stuck on the cutting member 812 or telescope/viewing apparatus802, a stylet can be passed through an auxiliary channel 208, in orderto bump the cutting member 812 or piece of stuck tissue or debris anddislodge it from the cutting member 812 or telescope/viewing apparatus802. Alternatively, a home position “groove” or recessed area,configured to closely conform to and accept the cutting member 812, canbe used to aid clearing of stuck tissue or debris from the cuttingmember 812 through return to this home position.

FIG. 15 illustrates, in simplified form, the portion 1300 of theresectoscope of FIG. 13 wherein the telescope or viewing apparatus 802has been moved ahead of the cutting member 812 as described above.

FIG. 16 illustrates, in simplified form, the portion 1300 of theresectoscope of FIG. 13 in an optional third configuration. In thisconfiguration, the resectoscope is optionally designed to lock thecutting member 812 at a position within the working area—illustrativelyshown in this example for simplicity at the midpoint of the range ofmotion. In this position, the cutting member 812 can be connected to apower source to effect cauterization or, for example in the case of acutting loop as shown in FIGS. 8 and 16, drag cutting of tissue (i.e.along a plane formed by the cutting member 812 or angled from that planewithin an angle θ as necessary. Again, it is worth noting that the shaft106 and/or periphery 1604 of the opening or resection port 124 will actto limit the depth of cut and reduce the risk of unwanted extraneouslacerations.

Of course, in some variants, the cutting member 812 can optionally beconfigured to cauterize throughout all, or in other variants a limitedportion, of the range of movement.

With respect to the use of the resectoscope, operationally, there aregenerally two home positions for the hand to accomplish the basicmovements used to employ many variants of a resectoscope 100 such asdescribed herein.

The first hand-home position is used to advance/retract the telescope orviewing apparatus 802 to/from the diagnostic position. In the diagnosticposition, an unobstructed panoramic view beyond the blunt distal tip 122is provided. To do so, the index and middle fingers grasp the shaft 106via the grip/stop 108 and the thumb rests on the handle 112 portion ofthe trolley 110. Movement of the thumb distally is used to advance thetelescope or viewing apparatus 802 and movement in the oppositedirection is used to retract the telescope or viewing apparatus 802 and,in some variants, that same movement thereby also controls the switch inthe distal end of the shaft. In the retracted position, a view of theworking area as well as a view external to the shaft 106 via the openingor resection port 124 is provided.

The second hand-home position is used to configure the resectoscope 100for surgical working (i.e. resection, drag cutting and/or cauterizationas well as targeting). In this position, the thumb is typically placedin the handle ring 502 and the forefinger is placed in the ring 402 ofthe control element 104. Since the cutting member 812 is connected tothe control element 104, the cutting member 812 is actuated by movementof the control element 104 via its ring 402 while the instrument isstabilized by the thumb being in the thumb hole 502. Alternatively, insome variants, the working position can involve placement of the indexfinger in the handle ring 502 (with the remaining fingers wrapped aroundthe back of the handle) and the thumb in the ring 402 of the controlelement 104. When used in this manner, movement of the thumb will movethe cutting member.

Alternatively, the resectoscope 100 is further configured so that theindex and middle fingers can pinch the finger grip 108 while the thumbworks the control element 104 or the trolley 110 from a side position.

Having described aspects of representative example devices incorporatingaspects of the invention, the operation of one example variant will nowbe described with reference to FIGS. 17, 18, 19 and 20 to illustrate theoperation of a resectoscope 100 using such variant with FIGS. 17-20specifically illustrating, in simplified form, different stages oftissue resection. For simplicity and purposes of contrast withconventional approaches, the operation of one such device will now bedescribed for the same procedure as described above in the “Background”section. As illustrated, the variant of this example employs a hybrid ofadjustable positive pressure infusion into the infusion channel from afree flow reservoir, and fluid return through the return channel isvacuum driven with optional boosting.

Just as in any prior method, the patient is positioned with adequateanalgesia, the cervix sterilized and dilated, except that here thedilation proceeds directly to the diameter of resection instrument, inthis example, around 10 millimeters.

Presuming that a fully disposable version or partially disposable kitversion is used, the pre-assembled instrument or the pertinent kitcomponent(s) is/are removed from one or more sterile packages, and if inkit form assembled, and if not simply removed ready for hookup to thetelescope 802, power source, and fluid/vacuum lines. After a quickvacuum driven flush, the telescope 802 is positioned to provide a viewout the distal tip through the window area (FIG. 13) and the instrumentis inserted into the cervix and directly into the uterine cavity withthe aid of its blunt, enclosed distal tip without significant concern oflaceration or puncture. Advantageously, due to its configuration, shouldthe surgeon encounter cervical polyps during insertion, they can beremoved as part of the entry process. Upon insertion to the uterinecavity the usual visual assessments are made with fluid infusionhydrometra.

After the surgeon has done the usual photo documentation and opticallyidentified the areas intended for resection, the instrument isreconfigured into the resection mode by a single hand motion to withdrawthe telescope 802 back to the resection position (FIG. 17) and bring thecutting member 812 into position. This also causes the infusion fluid tobegin circulating from the infusion channel 204 into the return channel206. Through minor external adjustment of the infusion fluid flow andreturn vacuum rates, fluid flow patterns are actively internalizedwithin the shaft 106 and re-made to serve the purposes of resection withconcurrent tissue exportation.

Next, the tissue to be resected is brought into proximity of theresection port (FIG. 18), and with optical guidance and low pressurevacuum, contact to the intended area is made.

Now, the protected cutting member is brought into motion (FIG. 19), inthis case removing a slice 1902 of tissue. Depending upon the particularpatient needs and size of the tissue to be resected, the cutting member812 may moved through the zone defined by the resection port multipletimes taking multiple slices, advantageously, without need forre-positioning or reassessment due to inherent depth control provided bythe surface 126 of the shaft 106. The resected tissue slice 1902 passesdown the shaft 106 proximally toward the handle assembly via the returnchannel 206 and, in this implementation, into the handle 102 bodythrough an opening in the channel floor just past the beginning of thefluid infusion port 204, for capture and retention either in the handle102 itself or an auxiliary container inserted in or associated with thehandle 102. In the event a slice of tissue 1902 becomes lodged on thecutting member 812, the telescope 802 can be independently moved forwardto dislodge it. Similarly, if smaller fragments or turbid fluid cloudthe end of the telescope 802, it can readily be moved into the cleanfluid flow for clearing without withdrawal from the patient or concernthat pathological tissue will be lost. In addition, a foot pedalactuated vacuum booster can be used in a pulsed fashion to furtheraugment clearance and export of tissue. If necessary, with someimplementations, the cutting member 812 can be further cleaned by returnto a rest position, for example, if the rest position is at a locationof maximum fluid flow or if a mechanical element is provided that isdesigned to clear the cutting member 812 through relative movement.

After tissue resection to the flush level, the instrument 100 can againbe reconfigured to the diagnostic conformation with a single hand motionand without withdrawal of the device from the patient, re-attaining theinitial diagnostic conformation, panoramic view, and fluid flow patternsto support post resection reassessment or documentation. Advantageously,with some implementations, if a bleeding vessel is encountered duringthe process, it can be treated by cauterization using, for example, thecutting member 812 itself with optical targeting, or in other variantimplementations where the cutting member 812 can not be used forcauterization, by an electrode that is passed through the auxiliarychannel 208 without, as would be required with conventional instruments,disassembly/reassembly to, for example, substitute a roller-ballelectrode.

Since, in this example, the resected tissue piece 1902 has been conveyedto and collected in the handle 102, the handle 102 can simply beremoved, closed or packaged and the tissue sent for pathologicalexamination without removal from the handle 102. Alternatively, if thehandle 102 holds or is connected to some other removable tissueconnection receptacle, that receptacle can be removed from the handle102 or its connection or, in some other variants, the tissue 1802 can beremoved from the handle 102 or other collection container and placed inthe appropriate receptacle for transfer to pathology for analysis.

Note that, throughout the procedure, no components need be fullywithdrawn from the patient and the external shape of the portion of thedevice contained within the patient does not change.

If all or part of the instrument is disposable, the disposable elementsare now discarded. If the device is not disposable, it is disassembled,cleaned, sterilized and repackaged in the conventional manner.

Based upon the above, it should be understood that different variantscan be used in many different medical disciplines for different surgicalapplications. For purposes of understanding, the following identifiessome representative examples of some surgical applications that canbenefit through use of one or more variants, it being understood thatthose enumerated are not intended to be exhaustive with respect to theparticular discipline or to the specific application(s) within anyparticular medical discipline.

In the area of cystoscopic and urologic surgery the applications areevident from the foregoing description with the shaft beingappropriately sized (length and cross section) for entry into theparticular body cavity.

In the area of neurosurgery the invention may be used to enterventricles, spaces, crevices or between cranial tissue lobes with visualassistance through the blunt enclosed distal tip and, with the telescopeor viewing apparatus withdrawn to the working position, to provide forsubstantially concurrent tissue excision and export from within theparticular area. In practice, intracranial spaces would be entered andviewed directly, for example, following a burr-hole craniotomy.Depending upon the particular circumstances a sealing grommet can beplaced to allow articulation of the instrument shaft around a softfulcrum like pivot. For such an application, the shaft would likely becurved or have at least some flex capability to allow it to bemaneuvered into spaces as needed.

In order to avoid increased intracranial pressures, where necessary, abrief fluid infusion via the export port(s) can be accomplishedconcurrent with or prior to incremental advancement of the instrument byusing rest phases and fluid pressure decompression to allow for venouscerebral circulation to resume. Utilizing the inherent depth ofresection control aspect provided by the resection port, the instrumentcan biopsy or remove tissues without the need for concurrent cavityinflation once the targeting and positioning movements are finished.Brief fluid re-infusion can then allow for overall assessment of theprogress if necessary.

In a similar fashion, variants can be used in microdiscectomy of thespine. Here an appropriately shaped and dimensioned shaft would bepassed through a small paraspinal incision through a ligamentum flavumwhile viewing through the blunt, enclosed distal tip. The shaft endwould be inserted between the disc and the nerve accompanied by slightfluid infusion would then provide additional space for movement. Thedistal section of the shaft would then be positioned so that the solidsurface would be positioned away from the disc and used as a retractor.Through peripheral viewing through the working area upon withdrawal ofthe telescope or viewing apparatus to the proximal side of the workingarea specific resectable tissue targeting will occur, followed byswitching to the fluid circulation mode and shaving or chipping away ofdisc or spinal tissue with an appropriate cutting member and concurrenttissue export towards the proximal end of the shaft.

In the area of chest and pulmonologic surgery variants could be used inbronchoscopy to enable targeted removal of lesions ranging fromsuspected cancer to warty tracheal growths or laryngeal or vocal chordpolyps or nodules. In such a case, the instrument would be usedinitially as a bronchoscope viewing through the blunt, enclosed distalend. Thereafter, targeting through the working area in conjunction withinternalized fluid circulation would be used to remove multiple lesionsquickly with concurrent cauterization of the base of the cut surface. Insuch a variant, an auxiliary port or additional soft and flexible tubewould be included and protrude from the distal tip to vacuum any fluidthat might exit or leak from the resection port during the actualcutting to avoid any flooding of the lung(s). Optionally oralternatively, a non-flammable, oxygen carrying fluid can be utilized asthe infusion fluid if necessary or desired. Advantageously, use of theinstant approach provides a speed advantage over laser ablation.

In the area of gastrointestinal surgery variants would be sized anddimensioned to allow for insertion, tissue biopsy and export with visualtargeting. Here the shaft would primarily be a long and flexiblefiberoptic shaft, as in the case of colonoscopic instruments generally,with only a small, rigid section near the distal end housing the workingarea and an intermediate reservoir piece intervening between the cuttingmember and the remainder of the flexible shaft.

In the area of cardiothoracic surgery variants could be used for biopsyof mediastinal cavity structures such as lymph nodes, or pericardialsurfaces. Here the variant could incorporate, or be used in conjunctionwith, a specialized chest tube to allow for evaluation and diagnosiswithin the pleural space. In such applications, the shaft would beconfigured to be articulable or of a pre-specified shape and would bepassed through a grommeted chest tube into the pleural space. Upon doingso, the shaft would be moved or articulated within the space to view andbiopsy pleural lesion such as mesotheliomas, lymphomas or other lesions.Optionally, the tip can be configured to rotate axially to allow forinitial drainage of a pyoma or malignant effusion via the chest tubewith immediate rinsing, viewing and possible biopsy without recourse tostandard thoracotomy incisions or multiple instrumentinsertion/removals.

In the area of orthopedic surgery variants can be sized and dimensionedto allow for passage into compartmental spaces or articular/joint spacesto allow for single incision joint space treatments.

In the area of maxillofacial surgery, variants would likely beconfigured to incorporate features applicable to the pulmonologicvariant such as an optional integral inferior aspirator tube to clearmucous and rinsing fluid. Again, the shaft would be of appropriatedimensions and likely be at least slightly flexible along at least aportion of its length. Insertion into the nasal or sinus cavities, aswith the above approaches, would occur while viewing through the blunt,enclosed distal end followed by specific targeting of, for example,polyps from the proximal side of the working area.

In all of the examples noted above, as well as any other non-enumeratedsurgical applications, owing to the tremendous variances among patientsthemselves, the numerous types and kinds of instances (as well astissues) for which such variants might be used, it is contemplated thata “one-size fits all” approach may not be suitable. Advantageously, toaccommodate such cases, variants incorporating the invention can becreated in kit form so that, immediately prior to or during the surgicaloperation, the surgeon can have, for example, multiple shafts or othercomponents available to them each of different configuration in terms ofdimensions, resection ports, cutting members, etc. so that specialized,multiple different, or initial inspection-discovered atypicalcircumstances can be accommodated by, for example, last minuteattachment of a particular shaft or changeover to a different shaft.While such cases could lead to more than one insertion, it is to beunderstood that such a disadvantage relative to single-insertion caseswould still represent a marked improvement over conventional approaches.

Moreover, there may be certain instances where a surgeon may be unableto determine prior to beginning a surgical operation whether a variantincorporating the invention or a conventional approach can be used.Advantageously, in such cases, one or more variants can be kept“on-hand”, the procedure can be initiated using a conventional approachand, should the need arise, the surgeon can quickly switch over to thevariant if necessary or advantageous.

As a final note with respect to potential applications, although all ofthe above variants have been described with respect to typical humansurgical applications, it is to be understood that the invention isapplicable to use in animals generally (i.e. is by no means limitedsolely to use in humans) although human surgical applications areexpected to be the primary use. Thus, it should be understood thatimplementations of the invention will have application in veterinarysurgical operations as well.

Thus, it will be appreciated that, in many of the above variants, exportof resected tissue occurs simply through fluid flow from the area of thedistal tip/working region back towards the handle at the proximal end.Moreover, due to the unique configurations of many variants, tissueexport can be augmented by using flow rates well in excess of what canbe used with conventional instruments. This can be illustrated withreference to a intrauterine hysteroscopic procedure, bearing in mindthat, increased flow rates may not be appropriate for all surgicalprocedures (i.e. where the tissue to be resected or the particular organinvolved could be unacceptably damaged by such a flow).

When performing hysteroscopic surgery, surgeons typically use a 1.5%glycine solution. This glycine solution is hypotonic because it only hasa 200-210 osmolarity, as compared with human serum which has better thanroughly a 280 osmolarity. As a result, it is dangerous to absorb becauseit can cause hyponatremia, a low sodium condition which can result incoma, brain edema or, if such a condition occurs and is corrected toorapidly, central pontine dysmyelinosis. Thus, when performingconventional hysteroscopic operations, infusion pressures must bemaintained during the entire operation and infusion pressure isintentionally limited in order to reduce and limit intravasation of theglycine solution. This limiting function is typically accomplishedthrough use of an infusion pump operating at a setting derived from theaverage mean arterial pressure and abdominal weight of the patient inconjunction with the general experience of the surgeon. Generally, thesetting is typically on the order of 75-80 mmHg (although the specificsetting will vary depending on the mean arterial pressure and abdominalweight for a given patient).

With a conventional 8 mm Olympus resectoscope of 30 cm length similar tothe resectoscope illustrated in U.S. Pat. No. 3,835,842 to Iglesias, afull open (i.e. maximum) infusion flow is about 1.2 liters per minute.

Based upon those parameters, it is expected that the same viscosity 1.5%glycine fluid used in a shaft according one variant of the inventionconfigured with: a 12 mm external diameter, a 10 mm internal diameter, alength of 30 cm, a 2.7 mm diameter scope in its channel, a 5 mm diameterinflow tube, and one or more export pores with a total area equal tothat of a single, circular export pore of 5 mm diameter, would beconfigured for a fluid infusion flow rate about equal to that ofconventional instruments (i.e. about 1.2 liters per minute).

However, in the internal circulation mode (e.g. where resection andtissue export would occur), an increased fluid pressure or vacuum assistcan readily be used to further advantage. Specifically, the internalizedflow rate could readily be increased to double, triple or more of themaximum infusion flow rate, in this example, a rate that would be inexcess of 4 liters per minute or more—a rate dramatically higher thanwould ever be used with conventional devices used in present surgicalprotocols. This is because, with conventional instruments, to the extentfluid is also drained by the instrument, the source for fluid is thebody cavity itself. Thus, any removal rate that is greater than theinflow rate will tend to collapse the cavity and the addition of vacuumwould only accelerate that collapse. In contrast, implementationvariants such as disclosed herein would generally not deflate the cavityat all in the internal circulation mode because it is a substantiallyclosed loop system (the possible exceptions being particularconfigurations where the window area is a hole that can not be blockedor where the resection port does not completely seal against the bodycavity surface near an edge). However, even there, since bursts can bevery short, cavity deflation risk is minimized notwithstanding the highfluid flow rate. In other words, with an internalized fluid circuitsourced by the inflow channel, a high flow rate can be used to exportresected tissue without appreciably altering inflation of the cavity.

Of course, it is to be understood that, irrespective of the size of theinflow channel, the internal circulation rate will be limited by thesmallest constriction through which the fluid will have to flow betweenthe source and the infusion channel. Thus, the limitation will typicallybe based upon the size of the inflow tube and source line. In otherwords, larger flow rates would generally require a larger diameterinflow tube or source line or both. However, as will be appreciated, alarger diameter inflow tube can readily be provided up to, including,and through, one having of a cross sectional area that is equal to thecross sectional area of the infusion channel in the shaft. In addition,since it is expected that vacuum boosted flow rates will occur inbursts—not continuously—the use of a conventional 3 mm source line isnot a problem if a sufficiently sized reservoir and inflow tube can beplaced between the source line and the infusion channel.

Thus, it is expected that comparably sized variants can generally useinternal circulation flow rates for tissue export (with or withoutvacuum assist) in excess of four times the rate of fluid infusion,thereby also providing reduced turbidity in the working area, moreefficient cleaning of the scope or viewing apparatus end and/or reducedrisk of a large piece of tissue becoming lodged within the shaft.

Although certain materials, features and configurations have beenidentified in connection with the above, they should not be consideredliterally the only materials, features or configurations that can beused. Particular materials, features and configurations will, to someextent, be determined by factors such as availability, cost,compatibility with the other components being used, compliance withregulations particular to surgical devices or manufacturing-relatedprocesses not pertinent to the inventive subject matter herein, only itsparticular implementation. Accordingly, it should be understood thatthose factors may result in a particular implementation having aconfiguration, features or materials that are not specifically describedherein but should be considered as being suitable and within thecontemplated scope, without specific itemization of all possiblealternatives thereof.

For example, it may be desirable to use different cross sectional shapesfor the shaft or its constituent channels for different applications. Inother words, different configurations of ovoid, round or othergeometric, non-geometric, symmetrical or non-symmetrical cross-sectionalshapes may be desirable. Still further, the cross sectional shape mayvary in different areas of the instrument. Similarly, differentapplications may make it desirable to use different orientations orgroupings of channels due to specific fluid flow, tissue export, orother operational needs and/or to change parameters of the instrumentitself to make it more suitable for a particular intended use, forexample, to accommodate particular configurations or types of cuttingmembers, deal with different organ particulars, increase or decreaseshaft stiffness or maintain a given shaft stiffness or flexibility fordifferent shaft diameters.

In some variants, tissue export can be augmented through use of amechanical conveyor of some form or multiple elements acting in concert,for example, flexible millipede-like “graspers” or “pushers” between theworking area and the location where the tissue exits the shaft or someform of “conveyor-belt”-like or large pitch helical screw arrangementwhich can be driven, for example, by the fluid flow in the shaft. Notehowever, that such an approach increases the mechanical complexity andconsequently the likelihood of mechanical problems or failure andrenders the instrument more difficult to clean and re-use. Nevertheless,such alternative approaches can be used from a pathology standpoint dueto the increased size of the resected tissue relative to that obtainedthrough current macerators or other resection devices used for similarpurposes.

Still further, with respect to materials, any material that meetssatisfies the intended use can be used in construction of the variouselements, e.g. the shaft, cutting member, distal tip, handle, etc. Forexample, if the instrument will be reusable, in whole or part, in someapplications, one or more of those components can be made from a metal,like stainless steel, or a polymer or polymer composite of suitablechemical or temperature resistance to enable it to withstand one or morere-sterilization cycles. One suitable example polymer is polyamideimide,also known as “PAI” or under the trade name Torlon® (a trademark of BPAmoco), which is commercially available form various suppliers includingQuadrant Engineering Plastics Products of Reading, Pa.(www.quadrantepp.com). Another suitable example polymer is apolyethylene terephthalate thermoplastic polyester resin that iscommercially available under the name Rynite® from E. I. du Pont deNemours & Co. or one of its distributors.

In cases where the instrument or any of its components will bedisposable after a single use, or may be re-usable a very limited numberof times, less expensive materials that still meet the requirements forthe particular component or action can be used, for example, lowtemperature plastics or materials that may only be suitable for a singleor limited use because, for example, they can not stand up tore-sterilization or can only stand up to limited re-sterilization.

It should thus be understood that this description (including thefigures) is only representative of some illustrative embodiments. Forthe convenience of the reader, the above description has focused on arepresentative sample of all possible embodiments, a sample that teachesthe principles of the invention. The description has not attempted toexhaustively enumerate all possible variations. That alternateembodiments may not have been presented for a specific portion of theinvention, or that further undescribed alternate embodiments may beavailable for a portion, is not to be considered a disclaimer of thosealternate embodiments. One of ordinary skill will appreciate that manyof those undescribed embodiments incorporate the same principles of theinvention as claimed and others are equivalent.

1. A surgical instrument comprising: a shaft having a proximal end and ablunt, enclosed distal end, the blunt, enclosed distal end beingoptically transparent over at least a portion of its area, the shaftfurther comprising a longitudinally extending fluid infusion channel, aside wall having an opening therein defining an enclosed working areawithin which resection can occur, a longitudinally extending returnchannel coupling the working area to a connection for a tissuecollection cavity, a viewing instrument channel dimensioned to receive aviewing instrument inserted from the proximal end and being positionedso as to enable the inserted viewing instrument to be moved to or fromi) a position near the portion of the blunt, enclosed distal end that isoptically transparent to provide unobstructed viewing through the blunt,enclosed distal end, and ii) a position to the proximal side of theenclosed working area to provide viewing of the enclosed working area,and at least one pore through which fluid passing from the proximal endof the shaft towards the blunt, enclosed distal end via the fluidinfusion channel can exit the shaft.
 2. The surgical instrument of claim1 further comprising: a switch, within the shaft, coupled to each of thefluid infusion channel, pore and return channel.
 3. The surgicalinstrument of claim 2 wherein the switch comprises one of a pivotingswitch or a sliding switch.
 4. The surgical instrument of claim 1wherein the optically transparent portion comprises: a membrane, aplate, a lens, or a surface of the shaft.
 5. The surgical instrument ofclaim 4 wherein the membrane, plate, lens or surface of the shaftincludes an in-shaft surface configured as a mirror image of an endsurface of a viewing instrument to facilitate abutting of the endsurface against the in-shaft surface.
 6. The surgical instrument ofclaim 1 wherein the optically transparent portion comprises: a hole. 7.The surgical instrument of claim 1 further comprising: a handle, havinga tissue receiving cavity therein, coupled to the return channel.
 8. Thesurgical instrument of claim 1 further comprising: a reflective surfacewithin the shaft and located relative to the viewing instrument channelso as to provide a viewing instrument within the viewing instrumentchannel with a view that is different from a view that can be obtainedby the viewing instrument alone.
 9. The surgical instrument of claim 1further comprising: a trolley, located near the proximal end, andconfigured to movably constrain the viewing instrument such thatmovement of the trolley will cause the inserted viewing instrument to bemoved between the position near the portion of the blunt, encloseddistal end and the position to the proximate side of the enclosedworking area.
 10. The surgical instrument of claim 1 further comprising:at least one auxiliary channel within the shaft.
 11. The surgicalinstrument of claim 10 wherein the auxiliary channel extends from nearthe proximal end to the working area.
 12. The surgical instrument ofclaim 10 wherein the auxiliary channel extends from near the proximalend to the blunt, enclosed distal end.
 13. The surgical instrument ofclaim 1 further comprising: a cutting member within the shaft.
 14. Thesurgical instrument of claim 13 wherein the cutting member comprises atleast one of: a wire loop, a blade, a scissor, a shutter or aharmonically vibrated cutter.
 15. The surgical instrument of claim 13wherein the cutting member is moveable solely within the working area.16. The surgical instrument of claim 13 further comprising: a cuttingmember home position and wherein the cutting member is normally biasedto the home position.
 17. The surgical instrument of claim 16 whereinthe cutting member home position is to the distal side of the workingarea.
 18. The surgical instrument of claim 16 wherein the cutting memberhome position is to the proximal side of the working area.
 19. Thesurgical instrument of claim 1 wherein: the opening in the side walldefining the enclosed working area comprises a closed geometric shape.20. The surgical instrument of claim 19 wherein the closed geometricshape is one of a circle, a quadrilateral or an ovoid.
 21. (canceled)22. (canceled)
 23. (canceled)
 24. (canceled)
 25. (canceled) 26.(canceled)
 27. (canceled)
 28. (canceled)
 29. (canceled)
 30. (canceled)31. A surgical instrument comprising: a shaft having a proximal end anda blunt, enclosed distal end, the blunt, enclosed distal end beingoptically transparent over at least a portion of its area, a scopehaving a viewing end that is moveable within the shaft between a firstposition and a second position such that i) when in the first positionwithin the shaft, the viewing end will be on a distal side of a workingarea within which resection can occur and proximate to the opticallytransparent portion of the distal end and provide an unobstructed viewexternal to the blunt, enclosed distal end; and ii) when in the secondposition within the shaft, the viewing end will be on a proximal side ofthe working area and provide a view of the working area.
 32. Thesurgical instrument of claim 31 further comprising: a trolley.
 33. Thesurgical instrument of claim 32 wherein the trolley comprises at leasttwo pits, each configured to receive an orientation pin of the scope.34. The surgical instrument of claim 31 wherein the viewing end of thescope comprises a beveled surface.
 35. The surgical instrument of claim34 wherein the portion of the optically transparent area comprises asection having a bevel that is configured for mating with the beveledsurface.
 36. The surgical instrument of claim 31 further comprising afluid routing switch configured for actuation by the scope when thescope is in the first position.
 37. (canceled)
 38. (canceled) 39.(canceled)
 40. (canceled)
 41. (canceled)
 42. (canceled)
 43. (canceled)44. A method comprising: a) inserting a shaft of a surgical instrument,having a blunt, enclosed distal end, into a body cavity while viewingthe insertion through the blunt, enclosed distal end via a viewingelement end positioned to the distal side of a working area near anoptically transparent portion of the distal end; b) establishing a fluidpath extending from near a proximal end of the shaft, through at least aportion of the shaft, to an export pore; c) withdrawing the viewingelement end to a proximal side of the working area; d) moving the shaftso that tissue to be resected is within the working area; e)establishing, within the shaft, a fluid circulation path that willdirect fluid along a path from the proximal side of the working areatowards the distal side of the working area without passing through theworking area, then from the distal side of the working area to theproximal side of the working area by passing through the working area;and f) resecting the tissue within the working area such that, once thetissue is resected, fluid in the fluid circulation path passing throughthe working area from the distal to the proximal side will convey theresected tissue away from the working area.
 45. The method of claim 44wherein step “d)” occurs one of concurrent with, before or after step“e)”.
 46. The method of claim 45 wherein, following “f)” the methodcomprises: discarding at least the shaft.
 47. The method of claim 45wherein, following “f)” the method comprises: sterilizing at least theshaft.
 48. The method of claim 45 further comprising: establishing, fora period of time, a rate of fluid flow through the export pore.
 49. Themethod of claim 48 wherein, while the fluid circulation rate isestablished, the method further comprises: establishing a fluid flowrate within at least a portion of the fluid circulation path that is atleast double what the rate of fluid flow was through the export porefollowing “b)”.
 50. The method of claim 48 wherein, while the fluidcirculation rate is established, the method further comprises:establishing a fluid flow rate within at least a portion of the fluidcirculation path that is at least triple what the rate of fluid flow wasthrough the export pore following “b)”.
 51. The method of claim 45further comprising: causing the fluid in at least a portion of the fluidcirculation path to flow at a rate of at least 4 liters/min.
 52. Themethod of claim 45 wherein, following “a)” the method further comprises:cauterizing tissue within the body cavity without withdrawing the blunt,enclosed distal end from the body cavity.
 53. The method of claim 45wherein, following “a)” the method further comprises: deploying a devicein the body cavity via an auxiliary channel within the shaft.
 54. Amethod comprising: viewing insertion of a shaft, having a blunt,enclosed distal end, into a body cavity through the blunt distal end viaan optical element located proximate to the distal end; causing a fluidflowing along the shaft from a proximal end to a distal end to exit theshaft through at least one export pore; changing a switch setting suchthat the fluid flowing in the proximal to distal direction will bypass aworking area and, once past the working area will flow in the distal toproximal direction and pass through the working area; and causing adiscrete piece of tissue to enter the working area so that it will beconveyed in the distal to proximal direction by the flow of the fluid.55. The method of claim 54 further comprising: causing the fluid to flowthrough the working area at a rate in excess of 4 liters/min.
 56. Themethod of claim 54 wherein the changing the switch setting comprises:moving one of a viewing instrument or a cutting member.
 57. The methodof claim 54 further comprising: providing a tissue collector near theproximal end of the shaft that will receive and retain the discretepiece of tissue.
 58. The method of claim 54 wherein the causing thediscrete piece of tissue to enter the working area comprises: moving acutting element in a proximal to distal direction.
 59. The method ofclaim 54 wherein the causing the discrete piece of tissue to enter theworking area comprises: moving a cutting element in a distal to proximaldirection.
 60. The method of claim 54 wherein, if the discrete piece oftissue becomes caught on a cutting member, the method comprises: movingat least one of the cutting member or a viewing instrument relative toeach other to dislodge the discrete piece of tissue.
 61. The method ofclaim 54 wherein, if the discrete piece of tissue becomes caught on acutting member, the method comprises: moving the cutting member withinthe flowing fluid.
 62. The method of claim 54 wherein, if the discretepiece of tissue becomes caught on a cutting member, the methodcomprises: inserting an object through an auxiliary channel in the shaftinto the working area in order to use the object to dislodge thediscrete piece of tissue without withdrawing any of a cutting member,viewing instrument or a section of the shaft containing the working areafrom the body cavity.
 63. The method of claim 54 wherein, if thediscrete piece of tissue becomes caught on a cutting member, the methodcomprises: returning the cutting member to a home position in order todislodge the discrete piece of tissue.
 64. A method comprising:providing a switch in a shaft for an instrument that can be used toresect tissue within a body cavity, the shaft having a proximal end anda distal end; defining a first position for the switch which will causefluid flowing in a channel in a proximal to distal direction to exit theshaft through at least one export pore located near the distal end; anddefining a second position for the switch, which will cause fluidflowing in the channel in the proximal to distal direction to remainwithin the shaft and be directed so as to pass through a working areawhere resection can occur to cause a piece of resected tissue to move ina distal to proximal direction within the shaft.
 65. The method of claim64 further comprising: defining at least one position between the firstand second positions wherein at least some of the fluid flowing in thechannel in the proximal to distal direction will exit the shaft throughthe at least one export pore and other of the fluid flowing in thechannel in the proximal to distal direction will remain within the shaftand be directed so as to pass through the working area and cause thepiece of resected tissue to move in the distal to proximal directionwithin the shaft.
 66. A method comprising: defining, in a shaft for aresectoscope having a blunt, enclosed distal end including an opticallytransparent area, a first location for a viewing instrument, the firstlocation being to the distal side of a working area but proximate to theoptically transparent area and the working area being defined by anopening in the shaft having a closed geometric shape that is located tothe proximal side of the enclosed distal end in a perimeter surface ofthe shaft, so that, when the viewing instrument is in the firstposition, a user using the viewing instrument will be able to see anarea external to and longitudinally removed from the distal end of theshaft via the optically transparent area; defining, in the shaft, asecond location for the viewing instrument, to the proximal side of theworking area, such that, when the viewing instrument is in the secondposition the user will be able to see resectable tissue of a body cavitythat is located within the working area; and defining the placement ofthe first position relative to the second position such that, theviewing instrument can be moved back and forth between the firstposition to the second position concurrent with export of tissue withinthe body cavity.
 67. A neurosurgical instrument comprising: a shaft,dimensioned for insertion through a cranial burr-hole, having a proximalend and a blunt, enclosed distal end, the blunt, enclosed distal endbeing optically transparent over at least a portion of its area, theshaft further comprising a longitudinally extending fluid infusionchannel, a side wall having an opening therein through whichfluid-induced intracranial pressure caused during insertion of the shaftcan be relieved, the opening further defining an enclosed working areawithin which resection can occur, a longitudinally extending returnchannel coupling the working area to a connection for a tissuecollection cavity, a viewing instrument channel dimensioned to receive aviewing instrument inserted from the proximal end and being positionedso as to enable the inserted viewing instrument to be moved to or fromi) a position near the portion of the blunt, enclosed distal end that isoptically transparent to provide unobstructed viewing of intracranialtissue through the blunt, enclosed distal end, and ii) a position to theproximate side of the enclosed working area to provide viewing of theenclosed working area, and at least one pore through which fluid passingfrom the proximal end of the shaft towards the blunt, enclosed distalend via the fluid infusion channel can periodically exit the shaft. 68.The neurosurgical instrument of claim 67 wherein: a portion of a body ofthe shaft is curved.
 69. The neurosurgical instrument of claim 67wherein: a portion of a body of the shaft is flexible.
 70. (canceled)71. A neurosurgical instrument comprising: a shaft, dimensioned forinsertion through a cranial burr-hole, and having a proximal end and ablunt, enclosed distal end, the blunt, enclosed distal end beingoptically transparent over at least a portion of its area, a scopehaving a viewing end that is moveable within the shaft between a firstposition and a second position such that i) when in the first positionwithin the shaft, the viewing end will be on a distal side of a workingarea within which resection can occur and proximate to the opticallytransparent portion of the distal end to provide an unobstructed view ofcranial tissue that is external to the blunt, enclosed distal end; andii) when in the second position within the shaft, the viewing end willbe on a proximal side of the working area and provide a view of theworking area.
 72. A neurosurgical method comprising: a) inserting ashaft of a neurosurgical instrument, having a blunt, enclosed distalend, through a burr-hole in a cranium while viewing the insertionthrough the blunt, enclosed distal end via a viewing element endpositioned to the distal side of a working area near an opticallytransparent portion of the distal end; b) establishing a fluid pathextending from near a proximal end of the shaft, through at least aportion of the shaft, to an export pore; c) briefly infusing a smallamount of fluid into the cranium; d) incrementally advancing the distalend within the cranium to a resection site; e) withdrawing the viewingelement end to a proximal side of the working area; f) moving the shaftso that tissue at the resection site that is to be resected is withinthe working area; g) establishing, within the shaft, a fluid circulationpath that will direct fluid along a path from the proximal side of theworking area towards the distal side of the working area without passingthrough the working area, then from the distal side of the working areato the proximal side of the working area and passing through the workingarea; and h) resecting the tissue within the working area such that,once the tissue is resected, fluid in the fluid circulation path passingthrough the working area from the distal to the proximal side willconvey the resected tissue away from the working area and towards theproximal end of the shaft.
 73. A spinal microdiscectomy instrumentcomprising: a shaft, dimensioned for insertion through a paraspinalincision, having a proximal end and a blunt, enclosed distal end, theblunt, enclosed distal end being optically transparent over at least aportion of its area, the shaft further comprising a longitudinallyextending fluid infusion channel, a side wall having an opening thereindefining an enclosed working area within which tissue resection canoccur, a longitudinally extending return channel coupling the workingarea to a connection for a tissue collection cavity, a viewinginstrument channel dimensioned to receive a viewing instrument insertedfrom the proximal end and being positioned so as to enable the insertedviewing instrument to be moved to or from i) a position near the portionof the blunt, enclosed distal end that is optically transparent toprovide unobstructed viewing of spinal disc tissue through the blunt,enclosed distal end, and ii) a position to the proximate side of theenclosed working area to provide viewing of spinal disc tissue that willbe resected within the enclosed working area.
 74. (canceled)
 75. Aspinal microdiscectomy instrument comprising: a shaft, dimensioned forinsertion through a paraspinal incision and having a proximal end and ablunt, enclosed distal end, the blunt, enclosed distal end beingoptically transparent over at least a portion of its area, a scopehaving a viewing end that is moveable within the shaft between a firstposition and a second position such that i) when in the first positionwithin the shaft, the viewing end will be on a distal side of a workingarea within which resection can occur and proximate to the opticallytransparent portion of the distal end to provide an unobstructed view ofspinal disc tissue external to the blunt, enclosed distal end; and ii)when in the second position within the shaft, the viewing end will be ona proximal side of the working area and provide a view of spinal disctissue within the working area.
 76. A method of performing a surgicalprocedure on spinal disc tissue comprising: a) inserting a shaft of aninstrument, having a blunt, enclosed distal end, through a paraspinalincision while viewing the insertion through the blunt, enclosed distalend via a viewing element end positioned to the distal side of a workingarea near an optically transparent portion of the distal end; b)establishing a fluid path extending from near a proximal end of theshaft, through at least a portion of the shaft, to an export pore tocreate a minimally inflated cavity; c) withdrawing the viewing elementend to a proximal side of the working area; d) moving the shaft so thattissue to be resected is within the working area; g) establishing,within the shaft, a fluid circulation path that will direct fluid alonga path from the proximal side of the working area towards the distalside of the working area without passing through the working area, thenfrom the distal side of the working area to the proximal side of theworking area and passing through the working area; and h) resecting thetissue within the working area such that, once the tissue is resected,fluid in the fluid circulation path passing through the working areafrom the distal to the proximal side will convey the resected tissueaway from the working area and towards the proximal end of the shaft.77. An instrument for use in thoracic surgery comprising: an articulableshaft dimensioned for insertion into the pleural space and having aproximal end and a blunt, enclosed distal end, the blunt, encloseddistal end being optically transparent over at least a portion of itsarea, the shaft further comprising a longitudinally extending fluidinfusion channel, a side wall having an opening therein defining anenclosed working area within which tissue resection can occur, alongitudinally extending return channel coupling the working area to aconnection for a tissue collection cavity, a viewing instrument channeldimensioned to receive a viewing instrument inserted from the proximalend and being positioned so as to enable the inserted viewing instrumentto be moved to or from i) a position near the portion of the blunt,enclosed distal end that is optically transparent to provideunobstructed viewing of tissue within the pleural space through theblunt, enclosed distal end, and ii) a position to the proximate side ofthe enclosed working area to provide viewing of tissue that will beresected within the enclosed working area.
 78. The instrument of claim77 further comprising: a longitudinally extending auxiliary channel,coupled to an auxiliary port, the auxiliary port extending the auxiliarychannel to a position external to the distal end, through which fluidexternal to the shaft can be drawn into the shaft by vacuum applied tothe auxiliary channel.
 79. The instrument of claim 77 wherein: a portionof the shaft containing the blunt, enclosed distal end is configured foraxial rotation.
 80. (canceled)
 81. An instrument for use in thoracicsurgery comprising: an articulable shaft, dimensioned for insertionthrough a chest tube into a pleural space, and having a proximal end anda blunt, enclosed distal end, the blunt, enclosed distal end beingoptically transparent over at least a portion of its area, an auxiliarychannel within the shaft through which fluid external to the shaft canbe drawn into the shaft by application of a vacuum to the auxiliarychannel; a scope having a viewing end that is moveable within the shaftbetween a first position and a second position such that i) when in thefirst position within the shaft, the viewing end will be on a distalside of a working area within which resection can occur and proximate tothe optically transparent portion of the distal end to provide anunobstructed view of tissue external to the blunt, enclosed distal endwithin a pleural space; and ii) when in the second position within theshaft, the viewing end will be on a proximal side of the working areaand provide a view of the working area.
 82. A method of performing athoracic surgical procedure comprising: a) inserting an articulableshaft of an instrument, having a blunt, enclosed distal end, into thechest cavity while viewing the insertion through the blunt, encloseddistal end via a viewing element end positioned to the distal side of aworking area near an optically transparent portion of the distal end; b)articulating the shaft in order to target tissue for resection; c)withdrawing the viewing element end to a proximal side of the workingarea; d) moving the shaft so that tissue to be resected is within theworking area; e) establishing, within the shaft, a fluid circulationpath that will direct fluid along a path from the proximal side of theworking area towards the distal side of the working area without passingthrough the working area, then from the distal side of the working areato the proximal side of the working area and passing through the workingarea; and f) resecting the tissue within the working area such that,once the tissue is resected, fluid in the fluid circulation path passingthrough the working area from the distal to the proximal side willconvey the resected tissue away from the working area and out of thechest cavity.
 83. An instrument for use in pulmonologic surgerycomprising: a shaft, dimensioned for insertion into one of a humanlaryngeal, tracheal or bronchial passage, the shaft having a proximalend and a blunt, enclosed distal end, the blunt, enclosed distal endbeing optically transparent over at least a portion of its area, theshaft further comprising a longitudinally extending fluid infusionchannel, a side wall having an opening therein defining an enclosedworking area within which resection can occur, a longitudinallyextending return channel coupling the working area to a connection for atissue collection cavity, an auxiliary channel coupled to an opening ina surface of the shaft through which fluid can be moved from external tothe shaft into the shaft by application of a vacuum to the auxiliarychannel; a viewing instrument channel dimensioned to receive a viewinginstrument inserted from the proximal end and being positioned so as toenable the inserted viewing instrument to be moved to or from i) aposition near the portion of the blunt, enclosed distal end that isoptically transparent to provide unobstructed viewing through the blunt,enclosed distal end, and ii) a position to the proximate side of theenclosed working area to provide viewing of the enclosed working area.84. The instrument of claim 83 wherein: the working area is within afirst portion of the shaft, the shaft comprises a second portion locatedbetween the first portion and the proximal end, and the second portionis flexible.
 85. (canceled)
 86. A surgical method comprising: a)inserting a shaft of an instrument, having a blunt, enclosed distal endinto one of a tracheal or bronchial passage of a human while viewing theinsertion through the blunt, enclosed distal end via a viewing elementend positioned to the distal side of a working area near an opticallytransparent portion of the distal end; b) visually locating tissue to beresected; c) withdrawing the viewing element end to a proximal side ofthe working area; d) moving the shaft so that at least a portion of thetissue to be resected is within the working area; e) viewing the portionvia the Original viewing element end; f) establishing, within the shaft,a fluid circulation path that will direct fluid along a path from theproximal side of the working area towards the distal side of the workingarea without passing through the working area, then from the distal sideof the working area to the proximal side of the working area and passingthrough the working area; and h) resecting the tissue within the workingarea such that, once the tissue is resected, the fluid in the fluidcirculation path passing through the working area from the distal to theproximal side will convey the resected tissue away from the working areaand towards the proximal end of the shaft.
 87. The method of claim 86,wherein, following “a)” the method further comprises: applying a vacuumto a channel within the shaft to facilitate movement of a substance fromexternal to the shaft into a passage within the shaft.
 88. The method ofclaim 86, wherein the fluid circulation path comprises a fluid infusionchannel, the method further comprising: introducing an oxygenated fluidinto a fluid infusion channel.
 89. An instrument for use ingastrointestinal surgery comprising: a shaft, dimensioned for insertioninto a section of the gastrointestinal tract of a human, the shafthaving a proximal end and a blunt, enclosed distal end, the blunt,enclosed distal end being optically transparent over at least a portionof its area, the shaft further comprising a longitudinally extendingfluid infusion channel, a side wall having an opening therein definingan enclosed working area within which resection can occur, alongitudinally extending return channel coupling the working area to aconnection for a tissue collection cavity, at least one fluid exportpore selectively connectable to the fluid infusion channel; a viewinginstrument channel dimensioned to receive a viewing instrument insertedfrom the proximal end and being positioned so as to enable the insertedviewing instrument to be moved to or from i) a position near the portionof the blunt, enclosed distal end that is optically transparent toprovide unobstructed viewing through the blunt, enclosed distal end, andii) a position to the proximate side of the enclosed working area toprovide viewing of the enclosed working area.
 90. The instrument ofclaim 89 wherein: the working area and blunt, enclosed distal end arewithin a first portion of the shaft, the shaft comprises a secondportion located between the first portion and the proximal end, and thesecond portion is flexible.
 91. (canceled)
 92. A gastrointestinalsurgical method comprising: a) inserting a shaft of an instrument,having a blunt, enclosed distal end into a portion of thegastrointestinal tract of a human while viewing the insertion throughthe blunt, enclosed distal end via a viewing element end positioned tothe distal side of a working area near an optically transparent portionof the distal end; b) visually locating tissue that is to be resected;c) withdrawing the viewing element end to a proximal side of the workingarea; d) moving the shaft so that at least some of the tissue to beresected is within the working area; e) viewing the at least some tissuevia the Original viewing element end; f) establishing, within the shaft,a fluid circulation path that will direct fluid along a path from theproximal side of the working area towards the distal side of the workingarea without passing through the working area, then from the distal sideof the working area to the proximal side of the working area and passingthrough the working area; and h) resecting the tissue within the workingarea such that, once the tissue is resected, the fluid in the fluidcirculation path passing through the working area from the distal to theproximal side will convey the resected tissue away from the working areaand towards the proximal end of the shaft.
 93. The method of claim 92,wherein, following “a)” the method further comprises: coupling a fluidinfusion channel to a fluid export pore to direct a flow of fluid fromthe fluid infusion channel to a location external to the shaft via thefluid export pore.
 94. A gynecological instrument comprising: a shaft,dimensioned for insertion through the cervix into the uterus, the shafthaving a proximal end and a blunt, enclosed distal end, the blunt,enclosed distal end being optically transparent over at least a portionof its area, the shaft further comprising a longitudinally extendingfluid infusion channel, a side wall having an opening therein definingan enclosed working area within which resection can occur, alongitudinally extending return channel coupling the working area to aconnection for a tissue collection cavity, a viewing instrument channeldimensioned to receive a viewing instrument inserted from the proximalend and being positioned so as to enable the inserted viewing instrumentto be moved to or from i) a position near the portion of the blunt,enclosed distal end that is optically transparent to provideunobstructed viewing through the blunt, enclosed distal end, and ii) aposition to the proximate side of the enclosed working area to provideviewing of the enclosed working area, and at least one pore throughwhich fluid passing from the proximal end of the shaft towards theblunt, enclosed distal end via the fluid infusion channel can exit theshaft to inflate the uterine cavity.
 95. The gynecological instrument ofclaim 94 wherein: the shaft is at least 14 cm long.
 96. Thegynecological instrument of claim 94 further comprising: an auxiliarychannel through which a ureteral stent can be deployed.
 97. Thegynecological instrument of claim 94 further comprising: an auxiliarychannel through which a tubal occlusion device for sterilization can bedeployed.
 98. (canceled)
 99. A gynecological instrument comprising: ashaft, dimensioned for insertion through the cervix into the uterus, andhaving a proximal end and a blunt, enclosed distal end, the blunt,enclosed distal end being optically transparent over at least a portionof its area, a scope having a viewing end that is moveable within theshaft between a first position and a second position such that i) whenin the first position within the shaft, the viewing end will be on adistal side of a working area within which resection can occur andproximate to the optically transparent portion of the distal end toprovide an unobstructed view of tissue external to the blunt, encloseddistal end; and ii) when in the second position within the shaft, theviewing end will be on a proximal side of the working area and provide aview of the working area.
 100. A gynecological method comprising: a)inserting a shaft of an instrument, having a blunt, enclosed distal end,into the uterus via the cervix while viewing the insertion through theblunt, enclosed distal end via a viewing element end positioned to thedistal side of a working area within the shaft near an opticallytransparent portion of the distal end; b) establishing a fluid pathextending from near a proximal end of the shaft, through at least aportion of the shaft, to an export pore; c) inflating the uterus; d)withdrawing the viewing element end to a proximal side of the workingarea; e) moving the shaft so that tissue to be resected is within theworking area; f) establishing, within the shaft, a fluid circulationpath that will direct fluid along a path from the proximal side of theworking area towards the distal side of the working area without passingthrough the working area, then from the distal side of the working areato the proximal side of the working area and passing through the workingarea; and g) resecting the tissue within the working area such that,once the tissue is resected, fluid in the fluid circulation path passingthrough the working area from the distal to the proximal side willconvey the resected tissue away from the working area and towards theproximal end of the shaft.
 101. The method of claim 100 furthercomprising: identifying a cervical polyp during the inserting; causingthe cervical polyp to enter the working area; and resecting the cervicalpolyp while it is within the working area.
 102. A urological instrumentcomprising: a shaft, dimensioned for insertion into the urethra, theshaft having a proximal end and a blunt, enclosed distal end, the blunt,enclosed distal end being optically transparent over at least a portionof its area, the shaft further comprising a longitudinally extendingfluid infusion channel, a side wall having an opening therein definingan enclosed working area within which resection of tissue from withinthe urinary tract can occur, a longitudinally extending return channelcoupling the working area to a connection for a tissue collectioncavity, a viewing instrument channel dimensioned to receive a viewinginstrument inserted from the proximal end and being positioned so as toenable the inserted viewing instrument to be moved to or from i) aposition near the portion of the blunt, enclosed distal end that isoptically transparent to provide unobstructed viewing through the blunt,enclosed distal end, and ii) a position to the proximate side of theenclosed working area to provide viewing of the enclosed working area,and at least one pore through which fluid passing from the proximal endof the shaft towards the blunt, enclosed distal end via the fluidinfusion channel can exit the shaft.
 103. The urological instrument ofclaim 102 further comprising: an auxiliary channel through which acatheter can be deployed.
 104. (canceled)
 105. A urological instrumentcomprising: a shaft, dimensioned for insertion into the urethra, andhaving a proximal end and a blunt, enclosed distal end, the blunt,enclosed distal end being optically transparent over at least a portionof its area, a scope having a viewing end that is moveable within theshaft between a first position and a second position such that i) whenin the first position within the shaft, the viewing end will be on adistal side of a working area within which resection can occur andproximate to the optically transparent portion of the distal end toprovide an unobstructed view of tissue external to the blunt, encloseddistal end; and ii) when in the second position within the shaft, theviewing end will be on a proximal side of the working area and provide aview of the working area.
 106. A urological method comprising: a)inserting a shaft of an instrument, having a blunt, enclosed distal end,into a portion of the urinary tract while viewing the insertion throughthe blunt, enclosed distal end via a viewing element end positioned tothe distal side of a working area within the shaft near an opticallytransparent portion of the distal end; b) establishing a fluid pathextending from near a proximal end of the shaft, through at least aportion of the shaft, to an export pore; c) withdrawing the viewingelement end to a proximal side of the working area; d) moving the shaftso that tissue to be resected is within the working area; e)establishing, within the shaft, a fluid circulation path that willdirect fluid along a path from the proximal side of the working areatowards the distal side of the working area without passing through theworking area, then from the distal side of the working area to theproximal side of the working area and passing through the working area;and f) resecting the tissue within the working area such that, once thetissue is resected, fluid in the fluid circulation path passing throughthe working area from the distal to the proximal side will convey theresected tissue away from the working area and towards the proximal endof the shaft.
 107. A surgical instrument comprising: a shaft,dimensioned for insertion into one of a facial, sinus or nasal cavity,the shaft having a proximal end and a blunt, enclosed distal end, theblunt, enclosed distal end being optically transparent over at least aportion of its area, the shaft further comprising a longitudinallyextending fluid infusion channel, a side wall having an opening thereindefining an enclosed working area within which resection of tissue fromthe cavity can occur, a longitudinally extending return channel couplingthe working area to a connection for a tissue collection cavity, aviewing instrument channel dimensioned to receive a viewing instrumentinserted from the proximal end and being positioned so as to enable theinserted viewing instrument to be moved to or from i) a position nearthe portion of the blunt, enclosed distal end that is opticallytransparent to provide unobstructed viewing through the blunt, encloseddistal end, and ii) a position to the proximate side of the enclosedworking area to provide viewing of the enclosed working area, and atleast one pore through which fluid passing from the proximal end of theshaft towards the blunt, enclosed distal end via the fluid infusionchannel can exit the shaft.
 108. The surgical instrument of claim 107further comprising: an auxiliary channel through which the facial cavitycan be aspirated.
 109. The surgical instrument of claim 107 wherein thefacial cavity is at least one of: a nasal cavity or a sinus. 110.(canceled)
 111. A surgical instrument comprising: a shaft, dimensionedfor insertion into a facial cavity, having a proximal end and a blunt,enclosed distal end, the blunt, enclosed distal end being opticallytransparent over at least a portion of its area, a scope having aviewing end that is moveable within the shaft between a first positionand a second position such that i) when in the first position within theshaft, the viewing end will be on a distal side of a working area withinwhich resection can occur and proximate to the optically transparentportion of the distal end to provide an unobstructed view of tissuewithin the facial cavity external to the blunt, enclosed distal end; andii) when in the second position within the shaft, the viewing end willbe on a proximal side of the working area and provide a view of theworking area.
 112. A surgical method comprising: a) inserting a shaft ofan instrument, having a blunt, enclosed distal end, into a facial cavitywhile viewing the insertion through the blunt, enclosed distal end via aviewing element end positioned to the distal side of a working areawithin the shaft and near an optically transparent portion of the distalend; b) withdrawing the viewing element end to a proximal side of theworking area; c) moving the shaft so that tissue to be resected from thefacial cavity is within the working area; d) establishing, within theshaft, a fluid circulation path that will direct fluid along a path fromthe proximal side of the working area towards the distal side of theworking area without passing through the working area, then from thedistal side of the working area to the proximal side of the working areaand passing through the working area; e) resecting the tissue within theworking area such that, once the tissue is resected, fluid in the fluidcirculation path passing through the working area from the distal to theproximal side will convey the resected tissue away from the working areaand towards the proximal end of the shaft.
 113. The surgical method ofclaim 112, further comprising: establishing a fluid path extending fromnear a proximal end of the shaft, through at least a portion of theshaft, to an export pore; and irrigating at least a portion of thefacial cavity.
 114. An instrument for use in proctological surgerycomprising: an elongated shaft, dimensioned for insertion into the bodyvia the anus, having a proximal end and a blunt, enclosed distal end,the blunt, enclosed distal end being optically transparent over at leasta portion of its area, the shaft further comprising a longitudinallyextending fluid infusion channel, a side wall having an opening thereindefining an enclosed working area within which resection can occur, alongitudinally extending return channel coupling the working area to aconnection for a tissue collection cavity, at least one fluid exportpore selectively connectable to the fluid infusion channel; a viewinginstrument channel dimensioned to receive a viewing instrument insertedfrom the proximal end and being positioned so as to enable the insertedviewing instrument to be moved to or from i) a position near the portionof the blunt, enclosed distal end that is optically transparent toprovide unobstructed viewing through the blunt, enclosed distal end, andii) a position to the proximate side of the enclosed working area toprovide viewing of the enclosed working area.
 115. The instrument ofclaim 114 wherein: the working area and blunt, enclosed distal end arewithin a first portion of the elongated shaft, the elongated shaftcomprises a second portion located between the first portion and theproximal end, and the second portion is flexible.
 116. (canceled)
 117. Aproctological surgical method comprising: a) inserting a shaft of aninstrument, having a blunt, enclosed distal end into a human via theanus while viewing the insertion through the blunt, enclosed distal endvia a viewing element end positioned to the distal side of a workingarea near an optically transparent portion of the distal end; b)visually locating tissue to be resected from within at least one of therectum or colon; c) withdrawing the viewing element end to a proximalside of the working area; d) moving the shaft so that at least some ofthe tissue to be resected is within the working area; e) viewing the atleast some tissue via the Original viewing element end; f) establishing,within the shaft, a fluid circulation path that will direct fluid alonga path from the proximal side of the working area towards the distalside of the working area without passing through the working area, thenfrom the distal side of the working area to the proximal side of theworking area and passing through the working area; and h) resecting thetissue within the working area such that, once the tissue is resected,the fluid in the fluid circulation path passing through the working areafrom the distal to the proximal side will convey the resected tissueaway from the working area and towards the proximal end of the shaft.118. The method of claim 117, wherein, following “a)” the method furthercomprises: coupling a fluid infusion channel to a fluid export pore todirect a flow of fluid from the fluid infusion channel to a locationexternal to the shaft via the fluid export pore.